Individual provider Active NPI

Bessie Lancelin, LCSW, CCDP

  • Clinical Social Worker
  • Pine Bluff, AR
National Provider Identifier
1194783456
Registry record updated Aug 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
152C Issued in AR
Practice address
2500 Rike Drive
Pine Bluff, AR 71603
Phone
(870) 534-1834
Fax
(870) 534-5798
NPI assigned
May 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2011

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 152C AR Primary

Addresses

Primary practice location

2500 Rike Drive
Pine Bluff, AR 71603

Mailing address

2500 Rike Drive
Pine Bluff, AR 71603
Phone (870) 534-1834

Other identifiers 1

IdentifierTypeStateIssuer
116378726MedicaidAR

Other names 1

  • Ms. Bessie Smith Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20100820000745 AR Practitioner - Clinical Social Worker 0345374740 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1974
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeast Arkansas Behavioral Healthcare System IncGroup PAC ID 0042292674, 16 clinicians

Practice addresses (Care Compare)

2500 Rike Dr
Pine Bluff, AR 71603-3937
Phone (870) 534-1834

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
152CARMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Arkansas Behavioral Healthcare System Inc CurrentSince Jul 1, 1990 Accepting new patients

Locations

2500 Rike Dr
Pine Bluff, AR 71603
Phone (870) 534-1834

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312156800000",
    "number": "1194783456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 RIKE DRIVE",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "71603",
            "telephone_number": "870-534-1834",
            "fax_number": "870-534-5798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 RIKE DRIVE",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "71603",
            "telephone_number": "870-534-1834",
            "fax_number": "870-534-5798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANCELIN",
        "first_name": "BESSIE",
        "credential": "LCSW, CCDP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-03",
        "last_updated": "2011-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "152C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "116378726",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BESSIE",
            "last_name": "SMITH",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Pine Bluff, AR

Sources for this page

Verify at the official NPI Registry.