Individual provider Active NPI

Marina Spacek

  • Clinical Social Worker
  • San Diego, CA
National Provider Identifier
1124653480
Registry record updated Mar 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
112587 Issued in CA
Practice address
1260 Morena Blvd Ste 100
San Diego, CA 92110-3850
Phone
(619) 398-0355
NPI assigned
Mar 6, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 112587 CA Primary

Addresses

Primary practice location

1260 Morena Blvd Ste 100
San Diego, CA 92110-3850

Mailing address

1260 Morena Blvd Ste 100
San Diego, CA 92110-3850
Phone (619) 398-0355

Other practice location 1

1202 Morena Blvd Ste 300
San Diego, CA 92110-3844
Phone (619) 275-0822

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230301002921 CA Practitioner - Clinical Social Worker 4688047293 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Research Foundation IncGroup PAC ID 6800825332, 63 clinicians

Practice addresses (Care Compare)

1260 Morena Blvd
Suite 100
San Diego, CA 92110-3850
Phone (619) 398-0355

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
112587CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Community Research Foundation Inc Clinical CurrentSince Feb 1, 2023 Accepting new patients

Locations

1202 Morena Blvd
Ste 100
San Diego, CA 92110
Phone (619) 276-8112

1202 Morena Blvd
Ste 300
San Diego, CA 92110
Phone (619) 276-8112

1260 Morena Blvd
Ste 100
San Diego, CA 92110
Phone (619) 398-0350

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.

NPI Registry JSON

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

{
    "created_epoch": "1583452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678060800000",
    "number": "1124653480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1260 MORENA BLVD STE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921103850",
            "telephone_number": "619-398-0355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 MORENA BLVD STE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921103850",
            "telephone_number": "619-398-0355"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1202 Morena Blvd Ste 300",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921103844",
            "country_code": "US",
            "telephone_number": "619-275-0822",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPACEK",
        "first_name": "MARINA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-06",
        "last_updated": "2023-03-06",
        "certification_date": "2023-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "112587",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.