Individual provider Active NPI

Laura Bruggemann, MSW

  • Social Worker
  • Las Cruces, NM
National Provider Identifier
1174802953
Registry record updated Aug 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
X-07179 Issued in NM
Practice address
3030 Jennifer St
Las Cruces, NM 88005-0900
Phone
(575) 650-0501
NPI assigned
Aug 10, 2011
Last updated
Aug 10, 2011By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 10, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X X-07179 NM Primary

Addresses

Primary practice location

3030 Jennifer St
Las Cruces, NM 88005-0900

Mailing address

3030 Jennifer St
Las Cruces, NM 88005-0900
Phone (575) 650-0501

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
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
I20200504002156 NM Practitioner - Clinical Social Worker 0042649360 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
4 Directions Integrative Mental Health LLCGroup PAC ID 1153750476, 4 clinicians

Practice addresses (Care Compare)

125 W Boutz Rd
Las Cruces, NM 88005-3118
Phone (575) 523-5222

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
X-07179NMMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
4 Directions Integrative Mental Health, LLC CurrentSince Sep 10, 2019 Accepting new patients

Locations

125 W Boutz Rd
Las Cruces, NM 88005
Phone (575) 523-5222

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.

NPI Registry JSON

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

{
    "created_epoch": "1312934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312934400000",
    "number": "1174802953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 JENNIFER ST",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880050900",
            "telephone_number": "575-650-0501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 JENNIFER ST",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880050900",
            "telephone_number": "575-650-0501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUGGEMANN",
        "first_name": "LAURA",
        "credential": "MSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-08-10",
        "last_updated": "2011-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NM",
            "license": "X-07179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Cruces, NM

Sources for this page

Verify at the official NPI Registry.