Individual provider Active NPI

Lyse M Debourguignon

  • Clinical Social Worker
  • Chapel Hill, NC
National Provider Identifier
1396786604
Registry record updated Apr 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
C005251 Issued in NC
Practice address
101 Manning Dr
Chapel Hill, NC 27599-0001
Phone
(919) 966-4131
NPI assigned
Jun 9, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2008

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 C005251 NC Primary

Addresses

Primary practice location

101 Manning Dr
Chapel Hill, NC 27599-0001

Mailing address

143 W Franklin St
Chapel Hill, NC 27516-2539

Other identifiers 1

IdentifierTypeStateIssuer
6106447MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20060711000222 NC Practitioner - Clinical Social Worker 3678586823 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of North Carolina at Chapel HillGroup PAC ID 0648181156, 2,028 clinicians

Practice addresses (Care Compare)

101 Manning Dr
Chapel Hill, NC 27514-4220

77 Vilcom Ctr Dr
Chapel Hill, NC 27514-1788

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
C005251NCMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
University of North Carolina at Chapel Hill CurrentSince Dec 21, 2009 Accepting new patients

Locations

200 N Greensboro St
Ste C6
Carrboro, NC 27510
Phone (919) 962-4919

110 Conner Dr
Ste 4
Chapel Hill, NC 27514
Phone (919) 926-8913

101 Manning Dr
#7160
Chapel Hill, NC 27514
Phone (984) 974-5217

77 Vilcom Center Dr
Ste 320
Chapel Hill, NC 27514
Phone (919) 962-1401

101 Manning Dr
Chapel Hill, NC 27514
Phone (984) 974-1485

Interoperability endpoints

  • Direct secure messaging: ldebourguignon12462@direct.unc.nchie.net

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": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208908800000",
    "number": "1396786604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "143 W FRANKLIN ST",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275162539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MANNING DR",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275990001",
            "telephone_number": "919-966-4131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEBOURGUIGNON",
        "first_name": "LYSE",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-09",
        "last_updated": "2008-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C005251",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6106447",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chapel Hill, NC

Sources for this page

Verify at the official NPI Registry.