Individual provider Active NPI

Marisa Jean Speer, PA-C

  • Physician Assistant
  • Sacramento, CA
National Provider Identifier
1376898544
Registry record updated Oct 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA58680 Issued in CA
Practice address
1495 River Park Dr Ste 200
Sacramento, CA 95815-4517
Phone
(916) 925-7020
Fax
(916) 925-3680
NPI assigned
Jul 13, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA58680 CA Primary

Addresses

Primary practice location

1495 River Park Dr Ste 200
Sacramento, CA 95815-4517

Mailing address

1495 River Park Dr Ste 200
Sacramento, CA 95815-4517
Phone (916) 925-7020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210218002116 CA Practitioner - Physician Assistant 1850706136 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA58680CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Skin Institute CurrentSince Dec 21, 2025 Accepting new patients

Locations

1495 River Park Dr
Ste 200
Sacramento, CA 95815
Phone (916) 925-6950

Interoperability endpoints

  • Direct secure messaging: mspeer234748@hpmg.direct-ci.net

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1342137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761004800000",
    "number": "1376898544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1495 RIVER PARK DR STE 200",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958154517",
            "telephone_number": "916-925-7020",
            "fax_number": "916-925-3680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1495 RIVER PARK DR STE 200",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958154517",
            "telephone_number": "916-925-7020",
            "fax_number": "916-925-3680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPEER",
        "first_name": "MARISA",
        "middle_name": "JEAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-13",
        "last_updated": "2025-10-21",
        "certification_date": "2025-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA58680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.