Individual provider Active NPI

Claire C. Tyler, MSW, LCSW

  • Clinical Social Worker
  • Jackson, MS
National Provider Identifier
1902152937
Registry record updated Jul 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
C6780 Issued in MS
Practice address
1059 Ridgewood PL
Jackson, MS 39211-2018
Phone
(601) 957-3211
Fax
(601) 957-9753
NPI assigned
Jul 27, 2012
Last updated
Jul 27, 2012By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 27, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X C6780 MS Primary

Addresses

Primary practice location

1059 Ridgewood PL
Jackson, MS 39211-2018

Mailing address

1059 Ridgewood PL
Jackson, MS 39211-2018
Phone (601) 957-3211

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170804002812 MS Practitioner - Clinical Social Worker 5799056032 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ridgewood Clinics PAGroup PAC ID 8224029871, 5 clinicians

Practice addresses (Care Compare)

1059 Ridgewood PL
Jackson, MS 39211-2018
Phone (601) 957-3211

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ridgewood Clinics PA CurrentSince Jun 26, 2017 Accepting new patients
Preferred PHP LLC PastSince May 9, 2021 Accepting new patients

Locations

1059 Ridgewood Pl
Jackson, MS 39211
Phone (601) 957-3211

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1343347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343347200000",
    "number": "1902152937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1059 RIDGEWOOD PL",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392112018",
            "telephone_number": "601-957-3211",
            "fax_number": "601-957-9753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1059 RIDGEWOOD PL",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392112018",
            "telephone_number": "601-957-3211",
            "fax_number": "601-957-9753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYLER",
        "first_name": "CLAIRE",
        "middle_name": "C.",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-27",
        "last_updated": "2012-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MS",
            "license": "C6780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.