Stephen A Spencer, MD PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

ME0047672 Issued in FL

Practice address

1617 Tamiami TRL
Port Charlotte, FL 33948-1040

Phone

(941) 613-2400

NPI assigned

Oct 12, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

DermatologyAlso: Micrographic Dermatologic Surgery (MDS)

Education

University of South Florida College of Medicine, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Leavitt Medical Associates of Florida IncGroup PAC ID 4688579311, 199 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Leavitt Medical Associates of Florida Inc

  dba Advanced Dermatology and Cosmetic Surq

  • Dermatology Physician
  • Sebastian, FL
  • NPI 1083872535
  Medicare reassignment Care Compare group NPD
• Stephen a Spencer MD.,PA

  • Specialist
  • Punta Gorda, FL
  • NPI 1154368884
  NPD (past) Authorized official
• Leavitt Medical Associates of Florida Inc

  dba Advanced Dermatology and Cosmetic Surgery

  • Dermatology Physician
  • Zephyrhills, FL
  • NPI 1518257229
  NPD
• Leavitt Medical Associates of Florida Inc

  dba Advanced Dermatology And Cosmetic Surgery

  • Dermatology Physician
  • Heathrow, FL
  • NPI 1528097284
  NPD (past)

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

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557446400000",
    "number": "1104814235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 SOUTHHALL LN",
            "address_2": "STE 300",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517172",
            "telephone_number": "407-875-2080",
            "fax_number": "407-650-3455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1617 TAMIAMI TRL",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339481040",
            "telephone_number": "941-613-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPENCER",
        "first_name": "STEPHEN",
        "middle_name": "A",
        "credential": "MD  PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-12",
        "last_updated": "2019-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME0047672",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5872736",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "08153",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "6417334",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "1255052",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Kathleen Spencer, M.S., CCC-SLP
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• St Vincent Depaul Volunteer Community Pharmacy (Virginia Andes Volunteer Community Pharmacy)

• Dermatology Physician in Port Charlotte, FL
• Providers in Port Charlotte, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.