Laurence W Spivack, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

36001535 Issued in OH

Practice address

9330 Hidden Glen Dr
Mentor, OH 44060

Phone

(440) 487-3947

Fax

(513) 858-7827

NPI assigned

Jun 16, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1043215817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9330 HIDDEN GLEN DR",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440607362",
            "telephone_number": "440-487-3947",
            "fax_number": "513-858-7827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9330 HIDDEN GLEN DR",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "44060",
            "telephone_number": "440-487-3947",
            "fax_number": "513-858-7827"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "35010 Chardon Rd Ste 101A",
            "address_purpose": "LOCATION",
            "city": "Willoughby Hills",
            "state": "OH",
            "postal_code": "440949011",
            "country_code": "US",
            "telephone_number": "440-953-3668",
            "fax_number": "440-953-3556",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "35010 Chardon Rd Ste 101A",
            "address_purpose": "LOCATION",
            "city": "Willoughby Hills",
            "state": "OH",
            "postal_code": "440949011",
            "country_code": "US",
            "telephone_number": "440-953-3668",
            "fax_number": "440-953-3556",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPIVACK",
        "first_name": "LAURENCE",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-16",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "OH",
            "license": "36001535",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000242733",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "016307",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0161999",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Spectera
• Lauren Spector, LSW
• Spectrum Diagnostic Imaging of Ohio LLC
• Paul T Spicuzza, ATC
• Claire G Spinks
• Katrina Spohn, LISW-S
• Sarah Sraj, M.S. CCC-SLP
• Paula Srsen, M.A., CCC-SLP
• Megan Staff, CNP
• Enrico Stahlschmidt, DPT, PT

• Podiatrist in Mentor, OH
• Providers in Mentor, OH by specialty
• Podiatrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.