NPIMap

Individual provider Active NPI

Michael Spivak, APRN, CNP

  • Family Nurse Practitioner
  • Mason, OH
National Provider Identifier
1437499076
Registry record updated Apr 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
NP-14261 Issued in OH
Practice address
969 Reading Rd Ste N
Mason, OH 45040-2654
Phone
(513) 604-1004
Fax
(513) 437-0571
NPI assigned
Feb 19, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NP-14261 OH Primary

Addresses

Primary practice location

969 Reading Rd Ste N
Mason, OH 45040-2654

Mailing address

5800 Trailside CT
Mason, OH 45040-7047
Phone (513) 891-3636

Other identifiers 2

IdentifierTypeStateIssuer
7100510650MedicaidKY
0079958MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130318000388 OH Practitioner - Nurse Practitioner 6901041144 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Cincinnati College of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Funcde, LLCGroup PAC ID 2264704139, 2 clinicians

Practice addresses (Care Compare)

969 Reading Rd
Suite N
Mason, OH 45040-2654
Phone (513) 604-1004

Hospital & facility affiliations

  • Bethesda North Hospital, Cincinnati, OH, CCN 360179
  • Good Samaritan Hospital Hospital, Cincinnati, OH, CCN 360134
  • Mercy Health - West Hospital Hospital, Cincinnati, OH, CCN 360234
  • Mercy Health - Fairfield Hospital Hospital, Fairfield, OH, CCN 360056
  • Christ Hospital Hospital, Cincinnati, OH, CCN 360163

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP-14261OHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Lima Memorial Joint Operating Company Past Accepting new patients

Organizations & group practices 2

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.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1361232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587513600000",
    "number": "1437499076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5800 TRAILSIDE CT",
            "city": "MASON",
            "state": "OH",
            "postal_code": "450407047",
            "telephone_number": "513-891-3636",
            "fax_number": "513-604-1005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "969 READING RD STE N",
            "city": "MASON",
            "state": "OH",
            "postal_code": "450402654",
            "telephone_number": "513-604-1004",
            "fax_number": "513-437-0571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPIVAK",
        "first_name": "MICHAEL",
        "credential": "APRN, CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-02-19",
        "last_updated": "2020-04-22",
        "certification_date": "2020-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "NP-14261",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100510650",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0079958",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mason, OH

Sources for this page

Verify at the official NPI Registry.