Individual provider Active NPI

Loida Elena Bicera Ruane, LMSW-CC

  • Clinical Social Worker
  • Bangor, ME
National Provider Identifier
1205010717
Registry record updated Jan 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
MC11402 Issued in ME
Practice address
40 Summer St
Bangor, ME 04401-6446
Phone
(207) 945-4240
Fax
(207) 299-1116
NPI assigned
Dec 19, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2010

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 MC11402 ME Primary

Addresses

Primary practice location

40 Summer St
Bangor, ME 04401-6446

Mailing address

110 Billings Rd
Hermon, ME 04401-0534
Phone (207) 848-4914

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
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
I20140127000104 ME Practitioner - Clinical Social Worker 1355570144 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2005
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Northern Lighthouse IncGroup PAC ID 2769611805, 5 clinicians

Practice addresses (Care Compare)

172 Academy St
Presque Isle, ME 04769-3165
Phone 2075401522104

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MC11402MEMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Watch Me Shine, Inc. CurrentSince Jul 24, 2018 Accepting new patients

Locations

28 Gilman Plz
Bangor, ME 04401
Phone (207) 990-0162

Organizations & group practices 2

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": "1198022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263772800000",
    "number": "1205010717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 BILLINGS RD",
            "city": "HERMON",
            "state": "ME",
            "postal_code": "044010534",
            "telephone_number": "207-848-4914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 SUMMER ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044016446",
            "telephone_number": "207-945-4240",
            "fax_number": "207-299-1116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUANE",
        "first_name": "LOIDA ELENA",
        "middle_name": "BICERA",
        "name_prefix": "Mrs.",
        "credential": "LMSW-CC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-19",
        "last_updated": "2010-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "MC11402",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

Verify at the official NPI Registry.