NPIMap

Individual provider Active NPI

Spencer A Bradford, PA-S2

  • Physician Assistant
  • Baltimore, MD
National Provider Identifier
1205478914
Registry record updated Oct 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
620 W Lexington St
Baltimore, MD 21201-1508
Phone
(970) 978-7005
NPI assigned
Oct 14, 2019
Last updated
Oct 22, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU Primary
Medical Physician Assistant 363AM0700X PA.0006388 CO

Addresses

Primary practice location

620 W Lexington St
Baltimore, MD 21201-1508

Mailing address

201 Lamkin St
Apt 101
Pueblo, CO 81003-3558
Phone (719) 543-6633

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210224001984 CO Practitioner - Physician Assistant 2567877509 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Catholic Health Initiatives ColoradoGroup PAC ID 8022927342, 1,230 clinicians

Practice addresses (Care Compare)

14300 Orchard Pkwy
Westminster, CO 80023-9206
Phone (720) 627-0207

14300 Orchard Pkwy Floor 2 Pod
1 Ornh Pain Specialists
Westminster, CO 80023-9206
Phone (303) 661-4100

41 State Hwy 67
Woodland Park, CO 80863-5008
Phone (719) 776-4780

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Catholic Health Initiatives Colorado CurrentSince Jul 1, 2022 Accepting new patients
Catholic Health Initiatives Colorado CurrentSince Jul 1, 2022 Accepting new patients
Catholic Health Initiatives Colorado Past Accepting new patients

Locations

9100 E Mineral Cir
Centennial, CO 80112
Phone (303) 561-5193

41 State Highway 67
Woodland Park, CO 80863
Phone (719) 686-0551

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1571011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761091200000",
    "number": "1205478914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 LAMKIN ST",
            "address_2": "APT 101",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810033558",
            "telephone_number": "719-543-6633",
            "fax_number": "719-543-6655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 W LEXINGTON ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011508",
            "telephone_number": "970-978-7005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADFORD",
        "first_name": "SPENCER",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "PA-S2",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-14",
        "last_updated": "2025-10-22",
        "certification_date": "2025-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "PA.0006388",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.