Stacia Roum
Individual provider Active NPI Clinical Social Worker · El Rito, NM
NPI 1801427695 · NPPES record last updated Sep 23, 2020
Key facts
- NPI
- 1801427695
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- C-11362 (NM)
- Practice address
- NM 571 BLDG 28
El Rito, NM 87530 - Phone
- (575) 581-4728
- Fax
- (575) 581-0030
- NPI assigned
- Jan 30, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Grace Integrated Solutions, LLC
Practice addresses (Care Compare)
Albuquerque, NM 87120
Phone (505) 944-6991
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210106001127 | NM | Practitioner - Clinical Social Worker | 0345653671 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M10379 | NM | MD | Social Worker |
| C-11362 | NM | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Las Clinicas del Norte Incorporated | Current |
Accepting new patients | |
| Grace Integrated Solutions, LLC | Current |
Accepting new patients | |
| Las Clinicas del Norte, Incorporated | Current |
Accepting new patients |
Locations
5800 McLeod Rd NE
Ste F
Albuquerque, NM 87109
Phone (505) 363-0250
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | M10379 | NM | |
| Clinical Social Worker | 1041C0700X | C-11362 | NM | Yes |
Addresses
Primary practice location
NM 571 BLDG 28
El Rito, NM 87530
Mailing address
PO Box 237
El Rito, NM 87530-0237
Phone (575) 581-4728
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 49475053 | Medicaid | NM |
Other providers in El Rito, NM
- Leann R Martinez-Archuleta
- Jennifer Joan Martinez
- Jeremy Angelo Martinez
- Mesa Vista Consolidated Schools
- Jessica Rodriguez
- Veronica M Sanchez
- Roy H. Scott
- Judith Lee Shaw
- Tamara Alynn Singleton
- Stepping Stones of Faith, LLC
All providers in El Rito, NM · Clinical Social Worker in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 23, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.