Jared S Spencer

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP6688 Issued in MN

Practice address

16180 Hastings Ave SE Ste 205
Prior Lake, MN 55372-9228

Phone

(952) 443-4600

NPI assigned

Nov 22, 2019

Last updated

Jul 7, 2021By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lorenz Clinic LLCGroup PAC ID 7810282845, 24 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/16506/brand/1/csg/1/fhir/r4
• Direct secure messaging: jared.spencer.1@16506.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lorenz Clinic, LLC

  • Marriage & Family Therapist
  • Victoria, MN
  • NPI 1982900510
  Medicare reassignment Care Compare group NPD
• Adam Shafer, P.C.

  dba Moonlightwellbeing

  • Clinical Psychologist
  • Chicago, IL
  • NPI 1659804003
  NPD (past)
• Shared Vision Psychological Services

  dba Shared Vision Psychological Services, dba Pediatric Psychology Assoc.

  • Clinical Psychologist
  • Oak Brook, IL
  • NPI 1275738130
  NPD (past)

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

{
    "created_epoch": "1574380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625616000000",
    "number": "1477199636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 51",
            "city": "VICTORIA",
            "state": "MN",
            "postal_code": "553860051",
            "telephone_number": "952-443-4600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16180 HASTINGS AVE SE STE 205",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553729228",
            "telephone_number": "952-443-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPENCER",
        "first_name": "JARED",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-22",
        "last_updated": "2021-07-07",
        "certification_date": "2021-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP6688",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.010179",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie Skovran, MT
• Sarah Slater, DNP
• Jett J. a. Snyder
• Snyders Drug (Snyder Drug Emporium)
• Terese Marie Sovis, MEDICAL MASSAGE THER
• Spratt Chiropractic, PLLC (Spratt Chiropractic, PLLC DBA Todd J. Spratt, DC)
• Todd J. Spratt, D.C.
• Jessica Lynn Spurrier
• Brittany Squillace, LMFT
• Paul Anthony Stahler, MD

• Clinical Psychologist in Prior Lake, MN
• Providers in Prior Lake, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2021; 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.
• 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.