Active NPI
Benjamin T Bencomo, LISW
- Clinical Social Worker
- Las Vegas, NM
National Provider Identifier
1083993406
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- I-07690
- Practice address
- 47 Alameda Rd
Las Vegas, NM 87701-3996 - Phone
- (505) 454-9738
- Fax
- (505) 425-9285
- NPI assigned
- Aug 16, 2011
- Last updated
- Aug 16, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | I-07690 | NM | Primary |
Addresses
Primary practice location
47 Alameda Rd
Las Vegas, NM 87701-3996
Mailing address
47 Alameda Rd
Las Vegas, NM 87701-3996
Phone (505) 454-9738
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| I-07690 | NM | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ride to Pride Partnership, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Las Vegas, NM
- NPI 1356756845
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1313452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313452800000",
"number": "1083993406",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "47 ALAMEDA RD",
"city": "LAS VEGAS",
"state": "NM",
"postal_code": "877013996",
"telephone_number": "505-454-9738",
"fax_number": "505-425-9285"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "47 ALAMEDA RD",
"city": "LAS VEGAS",
"state": "NM",
"postal_code": "877013996",
"telephone_number": "505-454-9738",
"fax_number": "505-425-9285"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENCOMO",
"first_name": "BENJAMIN",
"middle_name": "T",
"credential": "LISW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-08-16",
"last_updated": "2011-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NM",
"license": "I-07690",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.