Spencer Waller, FNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

ANP.0993430-NP Issued in CO

Practice address

400 W 16TH St
Pueblo, CO 81003-2781

Phone

(719) 584-4306

Fax

(719) 595-7886

NPI assigned

Oct 3, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Colorado Emergency Medical AssociatesGroup PAC ID 3870019524, 27 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Parkview Medical Center, Inc Hospital, Pueblo, CO, CCN 060020

Merit-based Incentive Payment System (MIPS)

Final score

77.65 of 100Reported as group

Quality

64.78

Improvement activities

40

Cost

70.76

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Southern Colorado Emergency Medical Associates

  dba Southern Colorado Emergency Medical Associates, Parkview Main

  • Emergency Medicine Physician
  • Pueblo, CO
  • NPI 1811793904
  Medicare reassignment Care Compare group NPD
• Southern Colorado Emergency Medical Associates

  dba Southern Colorado Emergency Medical Associates, Parkview Pueblo West

  • Emergency Medicine Physician
  • Pueblo West, CO
  • NPI 1861298960
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Parkview Medical Center, Inc

  • General Acute Care Hospital
  • Pueblo, CO
  • NPI 1184263527
  Care Compare affiliation
• Parkview Medical Center, Inc

  • General Acute Care Hospital
  • Pueblo, CO
  • NPI 1376183145
  Care Compare affiliation
• Parkview Medical Center, Inc

  • General Acute Care Hospital
  • Pueblo, CO
  • NPI 1417596834
  Care Compare affiliation
• Parkview Medical Center, Inc

  • General Acute Care Hospital
  • Pueblo, CO
  • NPI 1427689652
  Care Compare affiliation
• Parkview Medical Center, Inc.

  dba Parkview Medical Center

  • General Acute Care Hospital
  • Pueblo, CO
  • NPI 1104881507
  Care Compare affiliation
• Parkview Medical Center, Inc.

  • General Acute Care Hospital
  • Pueblo, CO
  • NPI 1134751712
  Care Compare affiliation
• Parkview Medical Center, Inc.

  dba Parkview Pueblo West

  • General Acute Care Hospital
  • Pueblo West, CO
  • NPI 1821720681
  Care Compare affiliation

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

{
    "created_epoch": "1506988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522281600000",
    "number": "1033629241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 W 16TH ST",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032781",
            "telephone_number": "719-584-4306",
            "fax_number": "719-595-7886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W 16TH ST",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032781",
            "telephone_number": "719-584-4306",
            "fax_number": "719-595-7886"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1619 N Greenwood St Ste 309",
            "address_purpose": "LOCATION",
            "city": "Pueblo",
            "state": "CO",
            "postal_code": "810032657",
            "country_code": "US",
            "telephone_number": "719-544-7115",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLER",
        "first_name": "SPENCER",
        "name_prefix": "Mr.",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-10-03",
        "last_updated": "2018-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CO",
            "license": "ANP.0993430-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dedra Wallace
• Victoria Lynn Wallace
• Holly Anna Waller, APN
• Jordan Waller
• Nancy Waller, PA
• Larry D Walls, MD
• Walmart Inc. (Walmart Pharmacy 10-5828)
• Walmart Inc. (Walmart Pharmacy 10-1001)
• Walmart Inc. (Walmart Pharmacy 10-0842)
• Walmart Inc. (Walmart Vision Center 30-0842)

• Nurse Practitioner in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Nurse Practitioner in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.