Individual provider Active NPI

Donna M Ruebensam, LCSW

  • Clinical Social Worker
  • Dyer, IN
National Provider Identifier
1639362841
Registry record updated Sep 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
34001717A Issued in IN
Practice address
24 Joliet St
Dyer, IN 46311-1705
Phone
(219) 322-5747
Fax
(219) 864-2282
NPI assigned
Aug 21, 2007
Last updated
Sep 13, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2023

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 34001717A IN Primary

Addresses

Primary practice location

24 Joliet St
Dyer, IN 46311-1705

Mailing address

PO Box 781076
Detroit, MI 48278-1076
Phone (317) 528-4800

Other identifiers 1

IdentifierTypeStateIssuer
90000854OtherILBCBSIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address druebensam3736@Direct.FranciscanAlliance.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20071203000604 IN Practitioner - Clinical Social Worker 6800985995 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Franciscan Physician NetworkGroup PAC ID 3072790682, 1,152 clinicians

Practice addresses (Care Compare)

5500 Hohman Ave
Suite 3a
Hammond, IN 46321-1942
Phone (219) 852-2513

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34001717AINMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Franciscan Physician Network CurrentSince Aug 1, 2011 Accepting new patients
Franciscan Physician Network CurrentSince Aug 1, 2011 Accepting new patients
St Margaret Mercy Healthcare Centers Past Accepting new patients
St Margaret Mercy Healthcare Centers Clinical Past Accepting new patients
St Margaret Mercy Healthcare Centers Past Accepting new patients
St Margaret Mercy Healthcare Centers Clinical Past Accepting new patients

Locations

1704 Lafayette Rd
Ste 4
Crawfordsvlle, IN 47933
Phone (765) 364-3120

24 Joliet St
Dyer, IN 46311
Phone (219) 864-2237

1040 Sierra Dr
Ste 400
Greenwood, IN 46143
Phone (317) 528-4886

5454 Hohman Ave
Hammond, IN 46320
Phone (219) 933-2077

5500 Hohman Ave
Ste 3A
Hammond, IN 46320
Phone (219) 852-2513

150 W Washington St
Shelbyville, IN 46176
Phone (317) 392-3211

Interoperability endpoints

  • Direct secure messaging: druebensam3736@direct.franciscanalliance.org

Organizations & group practices 6

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": "1187654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694563200000",
    "number": "1639362841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 781076",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482781076",
            "telephone_number": "317-528-4800",
            "fax_number": "317-865-1479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 JOLIET ST",
            "city": "DYER",
            "state": "IN",
            "postal_code": "463111705",
            "telephone_number": "219-322-5747",
            "fax_number": "219-864-2282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUEBENSAM",
        "first_name": "DONNA",
        "middle_name": "M",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-21",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34001717A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSIL",
            "identifier": "90000854",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "druebensam3736@Direct.FranciscanAlliance.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "24 Joliet St",
            "city": "Dyer",
            "state": "IN",
            "country_code": "US",
            "postal_code": "463111705",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Dyer, IN

Sources for this page

Verify at the official NPI Registry.