Mr Bruce Bernard Tisdale, DSW, LICSW, LCSW-C is a medicare enrolled "Social Worker - Clinical" provider in Suitland, Maryland. He graduated from healthcare school in 2004 and has 21 years of diverse experience with area of expertise as Clinical Social Worker. His current practice location is
5211 Auth Road St 203, Suitland, Maryland. You can reach out to his office (for appointments etc.) via phone at
(202) 257-6632.
Mr Bruce Bernard Tisdale is licensed to practice in Maryland (license number G11619) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1588816490.
Healthcare Provider's Profile
Full Name | Mr Bruce Bernard Tisdale |
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Gender | Male |
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Speciality | Clinical Social Worker |
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Experience | 21 Years |
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Location | 5211 Auth Road St 203, Suitland, Maryland |
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Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Medical Education and Training:
- Mr Bruce Bernard Tisdale graduated from medical school in 2004
NPI Data:
- NPI Number: 1588816490
- Provider Enumeration Date: 10/22/2008
- Last Update Date: 01/17/2024
Medicare PECOS Information:
- PECOS PAC ID: 7315104965
- Enrollment ID: I20120209000108
Medical Identifiers
Medical identifiers for Mr Bruce Bernard Tisdale such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1588816490 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
101YM0800X | Counselor - Mental Health | LC50078990 (District Of Columbia) | Secondary |
104100000X | Social Worker | (* (Not Available)) | Secondary |
1041C0700X | Social Worker - Clinical | LC50078990 (Maryland) | Secondary |
261QD1600X | Clinic/center - Developmental Disabilities | (* (Not Available)) | Secondary |
1041C0700X | Social Worker - Clinical | G11619 (Maryland) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mr Bruce Bernard Tisdale allows following entities to bill medicare on his behalf.
Entity Name | Hope 4 You Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1679948053 PECOS PAC ID: 3870892730 Enrollment ID: O20160427000407 |
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Entity Name | The Family Wellness Center Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1609141704 PECOS PAC ID: 9830406412 Enrollment ID: O20170221000149 |
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Entity Name | Kahak, Inc. |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1568638187 PECOS PAC ID: 6608299037 Enrollment ID: O20240608000158 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Bruce Bernard Tisdale is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Mr Bruce Bernard Tisdale, DSW, LICSW, LCSW-C 5805 Mcintosh Pl, Brandywine, MD 20613-7795 Ph: (202) 257-6632 | Mr Bruce Bernard Tisdale, DSW, LICSW, LCSW-C 5211 Auth Road St 203, Suitland, MD 20746 Ph: (202) 257-6632 |
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