Bluerock Medical LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

BLUEROCK MEDICAL LLC

Practice address

810 N Ridgewood Dr
Sebring, FL 33870-7217

Phone

(863) 873-0072

NPI assigned

Feb 7, 2024

Organization subpart

No

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

Authorized official

Name

Mrs. Jennie Leclair Spencer, DNP, APRN, FNP-CNPI 1164189015

Title

Owner

Phone

(863) 873-0072

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jennie Leclair Spencer, APRN, FNP-C

  • Family Medicine Physician
  • Sebring, FL
  • NPI 1164189015

  Multi-Specialty

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1707264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709510400000",
    "number": "1386408706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 SUMMIT DR",
            "city": "SEBRING",
            "state": "FL",
            "postal_code": "338702341",
            "telephone_number": "863-873-0072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 N RIDGEWOOD DR",
            "city": "SEBRING",
            "state": "FL",
            "postal_code": "338707217",
            "telephone_number": "863-873-0072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEROCK MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-07",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A",
        "authorized_official_last_name": "SPENCER",
        "authorized_official_first_name": "JENNIE",
        "authorized_official_middle_name": "LECLAIR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "863-873-0072",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DNP, APRN, FNP-C"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1164189015",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tricia Kay Blakeman, CST FA
• William Harold Blanchard, R.PH.
• Kristen Green Bloodworth, APRN, FNP- C
• Blossoms Therapy Center Inc. (Blossoms Developmental Therapy Associates)
• Blue Ocean Deramtology LLC
• Tanya Elizabeth Boatwright, ARNP FNP-C
• Yamaris Bobe, PSY.D
• Jenna Bogusky, ARNP
• Bond Clinic PA
• Bone and Joint Surgical Suites, LLC

• Family Medicine Physician in Sebring, FL
• Providers in Sebring, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.