NPIMap

Individual provider Active NPI

Robert Dale Spencer, P.A.

  • Physician Assistant
  • Moss Bluff, LA
National Provider Identifier
1104161025
Registry record updated Apr 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.200598 Issued in LA
Practice address
277 N Highway 171 Ste 8
Moss Bluff, LA 70611-5374
Phone
(337) 312-0030
NPI assigned
Dec 4, 2012
Last updated
Apr 12, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA.200598 LA Primary

Addresses

Primary practice location

277 N Highway 171 Ste 8
Moss Bluff, LA 70611-5374

Mailing address

501 Dr Michael Debakey Dr
Lake Charles, LA 70601-5724
Phone (337) 312-8360

Other identifiers 1

IdentifierTypeStateIssuer
2322885MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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
I20130503000526 LA Practitioner - Physician Assistant 2365689668 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lake Charles Urgent CareGroup PAC ID 1052580644, 14 clinicians
Lcuc Family Physicians Urgent Care LLCGroup PAC ID 8325327935, 13 clinicians

Practice addresses (Care Compare)

1905 Country Club Rd
Lake Charles, LA 70605-5203
Phone (337) 990-8000

2400 Ryan St
Lake Charles, LA 70601-7322
Phone (337) 433-1260

301 S Cities Service Hwy
Sulphur, LA 70663-6405
Phone (337) 888-3171

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA.200598LAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Imperial Health, LLP CurrentSince Jan 25, 2013 Accepting new patients
Lake Charles Primary Care and Wellness CurrentSince Oct 21, 2025 Accepting new patients
Calcasieu Urgent Care, LLC CurrentSince Aug 25, 2016 Accepting new patients
Calcasieu Urgent Care LLC CurrentSince Aug 25, 2016 Accepting new patients
Lourdes After Hours LLC CurrentSince Feb 27, 2019 Accepting new patients
Imperial Health LLP CurrentSince Jan 25, 2013 Accepting new patients

Locations

10319 Jefferson Hwy
Baton Rouge, LA 70809
Phone (224) 214-9352

3824 NE Evangeline Thruway
Carencro, LA 70520
Phone (337) 565-2675

1905 Country Club Rd
Lake Charles, LA 70605
Phone (337) 990-8000

1905 Country Club Rd
Ste B
Lake Charles, LA 70605
Phone (337) 990-8002

2640 Country Club Rd
Ste 400
Lake Charles, LA 70605
Phone (337) 426-0919

501 Dr Michael Debakey Dr
Lake Charles, LA 70601
Phone (337) 312-8258

277 N Highway 171
Ste 8
Moss Bluff, LA 70611
Phone (337) 312-0030

Interoperability endpoints

  • Direct secure messaging: rspencer5286166@direct.casso.us.com

Organizations & group practices 10

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 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": "1354579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618185600000",
    "number": "1104161025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 DR MICHAEL DEBAKEY DR",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706015724",
            "telephone_number": "337-312-8360",
            "fax_number": "337-312-6711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "277 N HIGHWAY 171 STE 8",
            "city": "MOSS BLUFF",
            "state": "LA",
            "postal_code": "706115374",
            "telephone_number": "337-312-0030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPENCER",
        "first_name": "ROBERT",
        "middle_name": "DALE",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-12-04",
        "last_updated": "2021-04-12",
        "certification_date": "2021-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "PA.200598",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2322885",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moss Bluff, LA

Sources for this page

Verify at the official NPI Registry.