NPIMap

Individual provider Active NPI

Clay R Spencer, M.D.

  • Family Medicine Physician
  • Walnut Ridge, AR
National Provider Identifier
1255413092
Registry record updated Jan 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
E3566 Issued in AR
Practice address
1210 W Main St
Walnut Ridge, AR 72476-1005
Phone
(870) 886-3543
Fax
(870) 886-3252
NPI assigned
Oct 20, 2006
Last updated
Jan 22, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X E3566 AR Primary

Addresses

Primary practice location

1210 W Main St
Walnut Ridge, AR 72476-1005

Mailing address

PO Box 719
Walnut Ridge, AR 72476-0719
Phone (870) 886-3543

Other identifiers 2

IdentifierTypeStateIssuer
5M488OtherARBLUE CROSS BLUE SHIELD
150630001MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20040629000620 AR Practitioner - Family Practice 0042296071 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Arkansas College of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1210 W Main St
Walnut Ridge, AR 72476-1005
Phone (870) 886-3543

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
E3566ARMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lawrence County Family Clinic, PA Family Medicine CurrentSince Jul 26, 2004 Accepting new patients
Northeast Arkansas Clinic, PA Past Accepting new patients
Lawrence County Family Clinic, PA Family Medicine Past Accepting new patients

Locations

1210 W Main St
Walnut Ridge, AR 72476
Phone (870) 886-3543

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lawrence County Family Clinic, PAWalnut Ridge, AR, CCN 043839 Rural health clinic 5% Or Greater Direct Ownership Interest Jul 26, 2004

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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 4

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": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1264118400000",
    "number": "1255413092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 719",
            "city": "WALNUT RIDGE",
            "state": "AR",
            "postal_code": "724760719",
            "telephone_number": "870-886-3543",
            "fax_number": "870-886-3252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 W MAIN ST",
            "city": "WALNUT RIDGE",
            "state": "AR",
            "postal_code": "724761005",
            "telephone_number": "870-886-3543",
            "fax_number": "870-886-3252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPENCER",
        "first_name": "CLAY",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-20",
        "last_updated": "2010-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E3566",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5M488",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150630001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Walnut Ridge, AR

Sources for this page

Verify at the official NPI Registry.