Michael Sebastian Spencer, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046010980 Issued in IL

Practice address

711 N Main St
Benton, IL 62812-1017

Phone

(618) 439-7256

NPI assigned

May 31, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

University of Missouri St Louis - School of Optometry, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Spencer Family Eye Care LLCGroup PAC ID 5698184695, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Spencer Family Eye Care, LLC

  • Optometrist
  • Benton, IL
  • NPI 1639754328
  Medicare reassignment Care Compare group NPD Authorized official
• Salem Eye Clinic LLC

  • Optometrist
  • Salem, IL
  • NPI 1205980786
  Medicare reassignment

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

{
    "created_epoch": "1464652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464652800000",
    "number": "1245688308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 N MAIN ST",
            "city": "BENTON",
            "state": "IL",
            "postal_code": "628121017",
            "telephone_number": "618-439-7256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 N MAIN ST",
            "city": "BENTON",
            "state": "IL",
            "postal_code": "628121017",
            "telephone_number": "618-439-7256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPENCER",
        "first_name": "MICHAEL",
        "middle_name": "SEBASTIAN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-05-31",
        "last_updated": "2016-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046010980",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southern Illinois Medical Services, NFP (Benton Community Healthcare)
• Southern Illinois Sport and Spine LLC
• Southern Illinois Therapy Services, PLLC
• Spencer Family Eye Care, LLC
• David Keith Spencer, O.D.
• Chelsea Steele
• Hannah Stock
• Stonebridge Nursing & Rehabilitation Center, LLC
• Stonebridge Senior Living Center, LLC
• Mariah Stubblefield, MSOTR/L

• Optometrist in Benton, IL
• Providers in Benton, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.