NPIMap

Individual provider Active NPI

Mary Spencer, FNP

  • Family Nurse Practitioner
  • Glenn Dale, MD
National Provider Identifier
1073966735
Registry record updated May 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R196874 Issued in MD
Practice address
8061 Springfield Rd
Glenn Dale, MD 20769-9605
Phone
(434) 390-6641
Fax
(240) 206-3855
NPI assigned
Jul 18, 2016
Last updated
May 1, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 1, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R196874 MD Primary

Addresses

Primary practice location

8061 Springfield Rd
Glenn Dale, MD 20769-9605

Mailing address

6415 Glenn Dale Rd
Glenn Dale, MD 20769-9288
Phone (434) 390-6641

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20161019000697 MD Practitioner - Nurse Practitioner 6901194224 Practice locations: Glenn Dale, MD
I20171218000154 DC Practitioner - Nurse Practitioner 6901194224 Practice locations: Glenn Dale, MD

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

8061 Springfield Rd
Glenn Dale, MD 20769-9605
Phone (434) 390-6641

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R196874MDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Spencer Family Practice LLC CurrentSince Jul 4, 2021 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: mary.spencer.1@21143.direct.athenahealth.com

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

Hospital & facility affiliations 10

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": "1468800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588291200000",
    "number": "1073966735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6415 GLENN DALE RD",
            "city": "GLENN DALE",
            "state": "MD",
            "postal_code": "207699288",
            "telephone_number": "434-390-6641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8061 SPRINGFIELD RD",
            "city": "GLENN DALE",
            "state": "MD",
            "postal_code": "207699605",
            "telephone_number": "434-390-6641",
            "fax_number": "240-206-3855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPENCER",
        "first_name": "MARY",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-18",
        "last_updated": "2020-05-01",
        "certification_date": "2020-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R196874",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glenn Dale, MD

Sources for this page

Verify at the official NPI Registry.