Individual provider Active NPI

Mary Spring, FNP-C

  • Family Nurse Practitioner
  • San Diego, CA
National Provider Identifier
1174209266
Registry record updated Jun 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95025399 Issued in CA
Practice address
1945 Garnet Ave
San Diego, CA 92109-3595
Phone
(858) 224-7977
NPI assigned
Jun 23, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2023

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 95025399 CA Primary

Addresses

Primary practice location

1945 Garnet Ave
San Diego, CA 92109-3595

Mailing address

12121 Scripps Summit Dr Ste 170
San Diego, CA 92131-4609

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: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230726000619 CA Practitioner - Nurse Practitioner 9739540618 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
SD Sports Medicine and Family Health Center CurrentSince Jul 10, 2023 Accepting new patients
Regents of the University of California Past Accepting new patients
Regents of the University of California Past Accepting new patients

Locations

6699 Alvarado Rd
Ste 101
San Diego, CA 92120

6699 Alvarado Rd
Ste 2100
San Diego, CA 92120
Phone (619) 229-3909

1945 Garnet Ave
San Diego, CA 92109
Phone (858) 224-7977

Organizations & group practices 3

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": "1687478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687478400000",
    "number": "1174209266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12121 SCRIPPS SUMMIT DR STE 170",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921314609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1945 GARNET AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921093595",
            "telephone_number": "858-224-7977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPRING",
        "first_name": "MARY",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-23",
        "last_updated": "2023-06-23",
        "certification_date": "2023-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95025399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.