NPIMap

Individual provider Active NPI

Cedric W. Spak, MD

  • Infectious Disease Physician
  • Provo, UT
National Provider Identifier
1063575199
Registry record updated Aug 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
14293240-1205 Issued in UT
Practice address
395 W Cougar Blvd Ste 202
Provo, UT 84604-3328
Phone
(801) 357-1772
NPI assigned
Dec 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease Physician 207RI0200X 14293240-1205 UT Primary
Infectious Disease Physician 207RI0200X L1206 TX
Infectious Disease Physician 207RI0200X MD00043412 WA

Addresses

Primary practice location

395 W Cougar Blvd Ste 202
Provo, UT 84604-3328

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128

Other practice location 1

1025 College Ave
Fort Worth, TX 76104-3013
Phone (817) 810-9810

Other identifiers 2

IdentifierTypeStateIssuer
8J4777OtherTXMEDICARE
145478703MedicaidTX

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io.8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark LLC / Office Ally

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070625000502 TX Practitioner - Infectious DiseasePractitioner - Internal Medicine 9931175924 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Infectious DiseaseAlso: Internal Medicine
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Texas Centers for Infectious Disease Associates PAGroup PAC ID 4880596451, 17 clinicians

Practice addresses (Care Compare)

3410 Worth St
Suite 780
Dallas, TX 75246-2046
Phone (817) 810-9810

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.77 of 100Reported as group
Quality
92.76
Improvement activities
40
Cost
78.94

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
L1206TXMDInfectious Disease Physician
MD00043412WAMDInfectious Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Texas Infectious Diseases Consultants CurrentSince Apr 1, 2007 Accepting new patients
Texas Centers for Infectious Disease Associates PA Infectious Disease CurrentSince Oct 1, 2016 Accepting new patients
Tarrant County Infectious Disease Associates Infectious Disease PastSince Oct 6, 2019 Accepting new patients
National Primary Care Network, PA Past Accepting new patients
North Texas Infectious Disaeases Consultants, PA PastSince May 10, 2020 Accepting new patients

Locations

3500 Gaston Ave
Dallas, TX 75246

3410 Worth St
Ste 780
Dallas, TX 75246
Phone (817) 810-9810

3409 Worth St
Ste 710
Dallas, TX 75246
Phone (214) 823-2533

3410 Worth St
Ste 790
Dallas, TX 75246
Phone (817) 810-9810

1025 College Ave
Fort Worth, TX 76104
Phone (817) 810-9810

1125 College Ave
Ft Worth, TX 76104
Phone (817) 336-1640

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GCCBBA
  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.60208

Organizations & group practices 5

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785801600000",
    "number": "1063575199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 W COUGAR BLVD STE 202",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043328",
            "telephone_number": "801-357-1772"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1025 College Ave",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "761043013",
            "country_code": "US",
            "telephone_number": "817-810-9810",
            "fax_number": "817-840-9815",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPAK",
        "first_name": "CEDRIC",
        "middle_name": "W.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-19",
        "last_updated": "2026-08-04",
        "certification_date": "2026-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "UT",
            "license": "14293240-1205",
            "primary": true
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "TX",
            "license": "L1206",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "WA",
            "license": "MD00043412",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "8J4777",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145478703",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io.8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC / Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "1300 SE Cardinal Ct Ste 190",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986839683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

Verify at the official NPI Registry.