Shirley Ann Spencer, M.A., QMHP

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

C4647 Issued in OR

Practice address

1200 Hilyard St
Eugene, OR 97401-8122

Phone

(458) 205-7080

Fax

(458) 205-7089

NPI assigned

Oct 20, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Undefined Non-Physician Type (Specify)

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Peacehealth Medical GroupGroup PAC ID 9032023270, 256 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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.

• Peacehealth Medical Group

  • Family Medicine Physician
  • Eugene, OR
  • NPI 1447207287

  Mental Health

  Medicare reassignment Care Compare group NPD
• Oslc Developments, Inc. - Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Eugene, OR
  • NPI 1326433012
  NPD (past)

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

{
    "created_epoch": "1476921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1306397666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 SHELTON MCMURPHEY BLVD",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974014928",
            "telephone_number": "541-485-2711",
            "fax_number": "888-975-0250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 HILYARD ST",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974018122",
            "telephone_number": "458-205-7080",
            "fax_number": "458-205-7089"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10 Shelton McMurphey Blvd",
            "address_purpose": "LOCATION",
            "city": "Eugene",
            "state": "OR",
            "postal_code": "974014928",
            "country_code": "US",
            "telephone_number": "541-485-2711",
            "fax_number": "888-975-0250",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPENCER",
        "first_name": "SHIRLEY",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "M.A., QMHP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-20",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "T-16-443",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "R3226",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "C4647",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500720361",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500716902",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Breanna Spehn
• Julia Ann Speir, LCSW
• Herron Jordanna Spence, M.A.
• Adam Spencer
• Naomi Spencer
• Jeffrey Bryon Sperla, NP
• Jessica Spevak Barbosa, IBCLC
• Spine Center of Eugene, Inc.
• Spine Surgery Center of Eugene, LLC
• Staci Lyn Spingola

• Professional Counselor in Eugene, OR
• Providers in Eugene, OR by specialty
• Professional Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.