NPIMap

Individual provider Active NPI

Spencer Godfrey

  • Nurse Practitioner
  • Lewiston, ID
National Provider Identifier
1073062295
Registry record updated Dec 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
62319 Issued in ID
Practice address
1203 Idaho St
Lewiston, ID 83501-1940
Phone
(208) 848-8300
NPI assigned
Sep 28, 2016
Last updated
Dec 13, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP60693813 WA
Nurse Practitioner 363L00000X 62319 ID Primary

Addresses

Primary practice location

1203 Idaho St
Lewiston, ID 83501-1940

Mailing address

611 N Iron Bridge Way
Spokane, WA 99202-4932
Phone (509) 444-8888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20191113001076 ID Practitioner - Nurse Practitioner 7719266717 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1203 Idaho St
Lewiston, ID 83501-1940
Phone (208) 848-8300

803 S Main St
Moscow, ID 83843-2695
Phone (208) 848-8300

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Association of Spokane Current Accepting new patients
Community Health Association of Spokane CurrentSince Sep 1, 2019 Accepting new patients
Community Health Association of Spokane CurrentSince Sep 1, 2019 Accepting new patients
Community Health Association of Spokane Past Accepting new patients
Tri Cities Community Health Past Accepting new patients

Locations

1203 Idaho St
Lewiston, ID 83501
Phone (208) 848-8300

338 6th St
Ste 101
Lewiston, ID 83501
Phone (208) 848-8290

803 S Main St
Ste 120
Moscow, ID 83843
Phone (208) 848-8300

203 N Washington St
Ste 300
Spokane, WA 99201

611 N Iron Bridge Way
Spokane, WA 99202

Interoperability endpoints

  • Direct secure messaging: spencer.godfrey.1@11411.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1475020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639353600000",
    "number": "1073062295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 N IRON BRIDGE WAY",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992024932",
            "telephone_number": "509-444-8888",
            "fax_number": "509-434-7806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 IDAHO ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835011940",
            "telephone_number": "208-848-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GODFREY",
        "first_name": "SPENCER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-09-28",
        "last_updated": "2021-12-13",
        "certification_date": "2021-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP60693813",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ID",
            "license": "62319",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewiston, ID

Sources for this page

Verify at the official NPI Registry.