Active NPI
Bryan Spruill, PA
- Medical Physician Assistant
- Texarkana, TX
National Provider Identifier
1376652289
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128b(4) exclusion effective Sep 20, 2022.
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA00599
- Practice address
- 5002 Cowhorn Creek Rd
Texarkana, TX 75503-9766 - Phone
- (903) 614-3008
- Fax
- (903) 614-3525
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA00599 | TX | Primary |
Addresses
Primary practice location
5002 Cowhorn Creek Rd
Texarkana, TX 75503-9766
Mailing address
5002 Cowhorn Creek Rd
Texarkana, TX 75503-9766
Phone (903) 614-3008
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8N3469 | Other | TX | BLUESHILED |
| 847N26 | Other | TX | BLUE CROSS BLUE SHIELD |
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)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307404800000",
"number": "1376652289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5002 COWHORN CREEK RD",
"city": "TEXARKANA",
"state": "TX",
"postal_code": "755039766",
"telephone_number": "903-614-3008",
"fax_number": "903-614-3525"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5002 COWHORN CREEK RD",
"city": "TEXARKANA",
"state": "TX",
"postal_code": "755039766",
"telephone_number": "903-614-3008",
"fax_number": "903-614-3525"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPRUILL",
"first_name": "BRYAN",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2011-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "TX",
"license": "PA00599",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUESHILED",
"identifier": "8N3469",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "847N26",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Texarkana, TX
- Special Health Resources for Texas, Incorporated
- Special Health Resources for Texas, Incorporated
- Speech Pathology Services
- Crystal Lites Speede, NP
- Kurt E Springmann, MD
- Lee R. Staats, LPC-I
- Carey Robert Stanley, OT
- Rachel Leah Stanley, FNP-C
- Susan Williams Stanley, MS, CCC, SLP
- Timothy D Stanley, MSLPE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.