TYLER THOMPSON SMITH (LCSW) – Clinical Social Worker, NPI 1093401929

TYLER THOMPSON SMITH (LCSW) is a healthcare provider. based in Johnson creek, Wisconsin. specializing in CLINICAL SOCIAL WORKER. They hold the professional credentials LCSW. They hold a License No. 12097-123 (WI). The NPI Number for TYLER THOMPSON SMITH (LCSW) is 1093401929

Main info

Male
3 Years Of Experience
Accepts Medicare Assignment
Name
TYLER THOMPSON SMITH (LCSW)
NPI
1093401929
Phone
Not provided
Address
504 MIDGE ST
Enumeration Date
13 April 2023
Last Update Date
26 February 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9203864094
Graduation Year
2023 (3 years ago)
PAC ID
4587187836
Group Practice PAC ID
2466475587
Professional Enrollment ID
I20250327003080
Address ID
WI530399512JU199XXDFXX403
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience30
Completeness75
Years active:3State licenses:1Digital endpointsOther names

1,447 CLINICAL SOCIAL WORKER in WI

Provider Addresses for TYLER THOMPSON SMITH (LCSW)

  • 504 MIDGE ST

    JOHNSON CREEK, WI 53038

    Phone:

    Type: Mailing

  • 199 COUNTY DF

    JUNEAU, WI 530399512

    Phone: (920) 386-3500

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2025-03-27

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20250327003080IClinical Social WorkerWITBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 53038)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 2466475587View full group profile
NameSpecialtyState
-WI
Clinical Social WorkerWI
Nurse PractitionerWI
Mental Health CounselorWI
Mental Health CounselorWI
Nurse PractitionerWI
Clinical Social WorkerWI
Mental Health CounselorWI
Clinical Social WorkerWI

Reviews

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Frequently asked questions

What is the standard ID for TYLER THOMPSON SMITH (LCSW) in the U.S.?
In the U.S., TYLER THOMPSON SMITH (LCSW) is identified by NPI 1093401929.
Is TYLER THOMPSON SMITH (LCSW) currently accepting referrals based on NPI status?
Registry metadata lists TYLER THOMPSON SMITH (LCSW) as active.
What type of care does TYLER THOMPSON SMITH (LCSW) provide?
TYLER THOMPSON SMITH (LCSW)'s profile centers on Clinical Social Worker. Clinical services aligned with this taxonomy classification.
Can patients visit TYLER THOMPSON SMITH (LCSW) in Johnson Creek, Wisconsin?
For routing, start with Johnson Creek, Wisconsin for TYLER THOMPSON SMITH (LCSW), then verify phone and hours locally.
Can I verify credentials using only NPI?
NPI confirms identity in the directory; licensure and board certification require separate checks.

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