Individual provider Active NPI

Blai Vang Spicer, P.A.

  • Physician Assistant
  • Winston Salem, NC
National Provider Identifier
1235148644
Registry record updated Mar 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
103363 Issued in NC
Practice address
4692 Brownsboro Rd
Winston Salem, NC 27106-3410
Phone
(336) 251-1114
Fax
(336) 251-1117
NPI assigned
Aug 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 103363 NC Primary

Addresses

Primary practice location

4692 Brownsboro Rd
Winston Salem, NC 27106-3410

Mailing address

4692 Brownsboro Rd
Winston Salem, NC 27106-3410
Phone (336) 251-1114

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20061030000094 NC Practitioner - Physician Assistant 6305843665 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
103363NCMDPhysician Assistant

Organizations & group practices 1

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": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774483200000",
    "number": "1235148644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4692 BROWNSBORO RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271063410",
            "telephone_number": "336-251-1114",
            "fax_number": "336-251-1117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4692 BROWNSBORO RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271063410",
            "telephone_number": "336-251-1114",
            "fax_number": "336-251-1117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPICER",
        "first_name": "BLAI",
        "middle_name": "VANG",
        "name_prefix": "Mrs.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-05",
        "last_updated": "2026-03-26",
        "certification_date": "2026-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "103363",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.