Active NPI
Judy Marie Spencer, PA-C
- Physician Assistant
- Summersville, WV
National Provider Identifier
1316922123
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 778
- Practice address
- 400 Fairview Heights Rd
Summersville, WV 26651-9308 - Phone
- (304) 872-8545
- Fax
- (304) 872-0675
- NPI assigned
- Dec 14, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 778 | WV | Primary |
Addresses
Primary practice location
400 Fairview Heights Rd
Summersville, WV 26651-9308
Mailing address
400 Fairview Heights Rd
Summersville, WV 26651-9308
Phone (304) 872-8545
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001771978 | Other | WV | MS BCBS |
| 3810000489 | Medicaid | WV |
Other names 1
- Judy Marie Bennett
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
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 778 | WV | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| West Virginia Em-I Medical Services | Physician Assistant | Past | Accepting new patients |
Interoperability endpoints
- jspencer@rhc.gwaydirect.com
- jspencer@yourcarecommunity.org
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Emergency Medicine Physician
- Summersville, WV
- NPI 1598148553
Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134518400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377648000000",
"number": "1316922123",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 FAIRVIEW HEIGHTS RD",
"city": "SUMMERSVILLE",
"state": "WV",
"postal_code": "266519308",
"telephone_number": "304-872-8545",
"fax_number": "304-872-0675"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 FAIRVIEW HEIGHTS RD",
"city": "SUMMERSVILLE",
"state": "WV",
"postal_code": "266519308",
"telephone_number": "304-872-8545",
"fax_number": "304-872-0675"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPENCER",
"first_name": "JUDY",
"middle_name": "MARIE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-12-14",
"last_updated": "2013-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WV",
"license": "778",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MS BCBS",
"identifier": "001771978",
"state": "WV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3810000489",
"state": "WV"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JUDY",
"last_name": "BENNETT",
"middle_name": "MARIE",
"credential": "PA-C",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Summersville, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.