Active NPI
Benjamin R Spence, CRM
- Peer Specialist
- Medford, OR
National Provider Identifier
1063970937
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 19-CRM-035
- Practice address
- 1025 E Main St
Medford, OR 97504-7448 - Phone
- (541) 779-1282
- Fax
- (541) 608-2888
- NPI assigned
- Mar 8, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 19-CRM-035 | OR | Primary |
Addresses
Primary practice location
1025 E Main St
Medford, OR 97504-7448
Mailing address
1003 E Main St Ste 104
Medford, OR 97504-7140
Phone (541) 326-4905
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19-CRM-035 | OR | MD | Peer Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Addictions Recovery Center, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Substance Abuse Rehabilitation Facility
- Medford, OR
- NPI 1346282035
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1552003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552003200000",
"number": "1063970937",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1003 E MAIN ST STE 104",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975047140",
"telephone_number": "541-326-4905"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1025 E MAIN ST",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975047448",
"telephone_number": "541-779-1282",
"fax_number": "541-608-2888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPENCE",
"first_name": "BENJAMIN",
"middle_name": "R",
"credential": "CRM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-03-08",
"last_updated": "2019-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OR",
"license": "19-CRM-035",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.