Kevan M Spencer, DO

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

0102202253 Issued in VA

Practice address

1 Jarrett White Rd
Tripler Army Medical Center, HI 96859-5001

Phone

(808) 433-6763

NPI assigned

Jan 12, 2007

Last updated

Sep 21, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695254400000",
    "number": "1467502039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 JARRETT WHITE RD",
            "city": "TRIPLER ARMY MEDICAL CENTER",
            "state": "HI",
            "postal_code": "968595001",
            "telephone_number": "808-433-6763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 JARRETT WHITE RD",
            "city": "TRIPLER ARMY MEDICAL CENTER",
            "state": "HI",
            "postal_code": "968595001",
            "telephone_number": "808-433-6763"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Building 6905 Harris Avenue",
            "address_purpose": "LOCATION",
            "city": "MCBH Hawaii",
            "state": "HI",
            "postal_code": "96734",
            "country_code": "US",
            "telephone_number": "808-257-3365",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPENCER",
        "first_name": "KEVAN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-12",
        "last_updated": "2023-09-21",
        "certification_date": "2023-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "VA",
            "license": "0102202253",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Somerall, OTD, OTR/L
• Ashley Nicole Soppe, MD
• Joshua Alan Sorge, DPT, OCS, CSCS
• Michaela Spaulding, PSYD
• Ave Spencer, DO
• George Bennett Stackhouse IV, M.D.
• Ryan Steck, DO
• Megan Sterling, D.O.
• Allison Sternberg, PHARMD
• Jayne Ryder Stevens, M.D.

• Physical Medicine & Rehabilitation Physician in Tripler Army Medical Center, HI
• Providers in Tripler Army Medical Center, HI by specialty
• Physical Medicine & Rehabilitation Physician in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.