Active NPI
Jason R Spruill, OCCUPATIONAL THERAP
- Occupational Therapist
- Elizabeth City, NC
National Provider Identifier
1205983384
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 4576
- Practice address
- 101 Medical Drive
Elizabeth City, NC 27909 - Phone
- (252) 338-2114
- Fax
- (252) 338-2115
- NPI assigned
- Jan 4, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 4576 | NC | Primary |
| Hand Occupational Therapist | 225XH1200X | 4576 | NC |
Addresses
Primary practice location
101 Medical Drive
Elizabeth City, NC 27909
Mailing address
101 Medical Drive
Elizabeth City, NC 27909
Phone (252) 338-2114
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7301483 | Medicaid | NC | |
| 1417N | Other | NC | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4576 | NC | MD | Hand Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coastal Rehabilitation Inc | Past | Accepting new patients | |
| Coastal Rehabilitation Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
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-
- Physical Therapist
- Moyock, NC
- NPI 1841317963
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214352000000",
"number": "1205983384",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 MEDICAL DRIVE",
"city": "ELIZABETH CITY",
"state": "NC",
"postal_code": "27909",
"telephone_number": "252-338-2114",
"fax_number": "252-338-2115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 MEDICAL DRIVE",
"city": "ELIZABETH CITY",
"state": "NC",
"postal_code": "27909",
"telephone_number": "252-338-2114",
"fax_number": "252-338-2115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPRUILL",
"first_name": "JASON",
"middle_name": "R",
"name_prefix": "Mr.",
"credential": "OCCUPATIONAL THERAP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-04",
"last_updated": "2008-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NC",
"license": "4576",
"primary": true
},
{
"code": "225XH1200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Hand",
"state": "NC",
"license": "4576",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7301483",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "1417N",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elizabeth City, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.