Individual provider Active NPI

Laura N Douglas

  • Clinical Social Worker
  • Bend, OR
National Provider Identifier
1396044624
Registry record updated Dec 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L7193 Issued in OR
Practice address
2577 NE Courtney Dr
Bend, OR 97701-7638
Phone
(541) 322-7500
NPI assigned
Mar 25, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 1, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Clinical Social Worker 1041C0700X
Clinical Social Worker 1041C0700X L7193 OR Primary

Addresses

Primary practice location

2577 NE Courtney Dr
Bend, OR 97701-7638

Mailing address

2577 NE Courtney Dr
Bend, OR 97701-7638
Phone (541) 322-7500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20170908002017 OR Practitioner - Clinical Social Worker 5698048817 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Deschutes County Oregon CurrentSince Aug 1, 2017 Accepting new patients
Deschutes County Oregon CurrentSince Aug 1, 2017 Accepting new patients

Locations

2577 NE Courtney Dr
Bend, OR 97701
Phone (541) 322-7400

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": "1301011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512086400000",
    "number": "1396044624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2577 NE COURTNEY DR",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977017638",
            "telephone_number": "541-322-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2577 NE COURTNEY DR",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977017638",
            "telephone_number": "541-322-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "LAURA",
        "middle_name": "N",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-03-25",
        "last_updated": "2017-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L7193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

Verify at the official NPI Registry.