Spine and Neurosurgical Trauma Associates of Northern California

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

13305 Issued in CA

Legal business name

SPINE AND NEUROSURGICAL TRAUMA ASSOCIATES OF NORTHERN CALIFORNIA

Practice address

4690 Hoen Ave
Santa Rosa, CA 95405-7823

Phone

(707) 799-5911

NPI assigned

Sep 17, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Scott Glickman, DO

Title

President

Phone

(707) 799-5911

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• NorCal Neurosurgery Group Doing business as

Locations

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

{
    "created_epoch": "1410912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410912000000",
    "number": "1174925697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1275 4TH ST",
            "address_2": "PMB 646",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954044057",
            "telephone_number": "707-799-5911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4690 HOEN AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954057823",
            "telephone_number": "707-799-5911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE AND NEUROSURGICAL TRAUMA ASSOCIATES OF NORTHERN CALIFORNIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-17",
        "last_updated": "2014-09-17",
        "status": "A",
        "authorized_official_last_name": "GLICKMAN",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "707-799-5911",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neurological Surgery",
            "state": "CA",
            "license": "13305",
            "primary": true
        },
        {
            "code": "2084V0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Vascular Neurology",
            "state": "CA",
            "license": "13305",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3102403",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NorCal Neurosurgery Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• John Daniel Spenst, M.D.
• Terrie Lynne Spenst, RNNP
• Derek Brandon Spiekerman, M.S.
• Lauren Spieler, DO
• Michael David Spielman, MFT
• Deian Andrei Spinean
• Louise Elaine Spiva, CMT
• Patricia P. Spiva, PSY.D.
• Megan N Sprague
• Sharm Sprague

• Neurological Surgery Physician in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Neurological Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.