NPIMap

Organization Active NPI

Fort Myers Psychology, PA

  • Clinical Psychologist
  • Fort Myers, FL
National Provider Identifier
1003028119
Registry record updated Dec 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
FORT MYERS PSYCHOLOGY, PA
Practice address
12791 World Plaza LN BLDG 89
Fort Myers, FL 33907-3989
Phone
(239) 829-5494
Fax
(239) 645-4777
NPI assigned
May 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2024

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

Authorized official

Name
Brenda K Sluder
Title
Office Billing Administrator
Phone
(239) 887-6004

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X Primary

Addresses

Primary practice location

12791 World Plaza LN BLDG 89
Fort Myers, FL 33907-3989

Mailing address

8430 Belle Meade Dr
Fort Myers, FL 33908-6009
Phone (239) 826-7903

Other identifiers 2

IdentifierTypeStateIssuer
74129OtherFLBCBS FLORIDA
NJ5TQOtherFLBCBS-FL BLUE

Other names 1

  • Nancy T Spencer PsyD, PA Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070702000495 FL Part B Supplier - Clinic/Group Practice 6204936305 Receives reassigned benefits from 11 practitioners
Practice locations: Fort Myers, FL

National Provider Directory

National Provider Directory

Locations

8140 College Pkwy
#101B
Fort Myers, FL 33919
Phone (239) 826-7903

12641 World Plaza Ln
#56
Fort Myers, FL 33907
Phone (239) 274-3846

12791 World Plaza Ln
Bldg 89
Fort Myers, FL 33907
Phone (239) 247-1756

600 Tarpon Bay Rd
Sanibel, FL 33957
Phone (239) 395-2444

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734307200000",
    "number": "1003028119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8430 BELLE MEADE DR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339086009",
            "telephone_number": "239-826-7903",
            "fax_number": "239-645-4777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12791 WORLD PLAZA LN BLDG 89",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339073989",
            "telephone_number": "239-829-5494",
            "fax_number": "239-645-4777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT MYERS PSYCHOLOGY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-16",
        "status": "A",
        "authorized_official_last_name": "SLUDER",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OFFICE BILLING ADMINISTRATOR",
        "authorized_official_telephone_number": "239-887-6004"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FLORIDA",
            "identifier": "74129",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS-FL BLUE",
            "identifier": "NJ5TQ",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nancy T Spencer PsyD, PA",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.