NPIMap

Organization Active NPI

Myspectrum LLC

  • Mental Health Counselor
  • North Chesterfield, VA
National Provider Identifier
1174029359
Registry record updated Jun 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
MYSPECTRUM LLC
Practice address
707 N Courthouse Rd
North Chesterfield, VA 23236-4045
Phone
(804) 332-5696
Fax
(866) 626-4469
NPI assigned
Apr 5, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2019

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

Authorized official

Name
Suzanne ChristopherNPI 1033371778
Title
Director
Phone
(804) 332-5696

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

707 N Courthouse Rd
North Chesterfield, VA 23236-4045

Mailing address

707 N Courthouse Rd
North Chesterfield, VA 23236-4045
Phone (804) 332-5696

Other identifiers 1

IdentifierTypeStateIssuer
1174029359MedicaidVA

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL www.myspectrumcc.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190422001369 VA Part B Supplier - Clinic/Group Practice 5799027843 Receives reassigned benefits from 48 practitioners
Practice locations: North Chesterfield, VA
O20260515000175 TX Part B Supplier - Clinic/Group Practice 5799027843 Receives reassigned benefits from 1 practitioner
Practice locations: Mansfield, TX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 56

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 56

NPI Registry JSON

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

{
    "created_epoch": "1522886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561075200000",
    "number": "1174029359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 N COURTHOUSE RD",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232364045",
            "telephone_number": "804-332-5696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 N COURTHOUSE RD",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232364045",
            "telephone_number": "804-332-5696",
            "fax_number": "866-626-4469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYSPECTRUM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-05",
        "last_updated": "2019-06-21",
        "status": "A",
        "authorized_official_last_name": "CHRISTOPHER",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "804-332-5696"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174029359",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.myspectrumcc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "website",
            "address_1": "707 N Courthouse Rd",
            "city": "North Chesterfield",
            "state": "VA",
            "country_code": "US",
            "postal_code": "232364045",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in North Chesterfield, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.