Nicole Anastasia Spooner, NURSE PRACTITIONER

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95005748 Issued in CA

Practice address

1612 Julia St
Berkeley, CA 94703

Phone

(415) 307-4566

Fax

(415) 206-4153

NPI assigned

Jun 10, 2010

Sex

Female

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 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

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Union Square Dermatology a Professional CorporationGroup PAC ID 1355406174, 4 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Union Square Dermatology a Professional Corporation

  • Dermatology Physician
  • San Francisco, CA
  • NPI 1023263613
  Medicare reassignment Care Compare group NPD
• John Muir Health

  • General Acute Care Hospital
  • Concord, CA
  • NPI 1801821376
  NPD (past)
• Sutter Bay Medical Foundation

  • Multi-Specialty Clinic/Center
  • Palo Alto, CA
  • NPI 1013950807
  NPD (past)
• Sutter East Bay Medical Foundation

  • Family Medicine Physician
  • Orinda, CA
  • NPI 1871538769
  NPD (past)
• Vail Reese Union Square Dermatology

  • Dermatology Physician
  • San Francisco, CA
  • NPI 1295759835
  NPD (past)

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

{
    "created_epoch": "1276128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530748800000",
    "number": "1508186644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1612 JULIA ST",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947032018",
            "telephone_number": "415-307-4566",
            "fax_number": "415-206-4153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1612 JULIA ST",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "94703",
            "telephone_number": "415-307-4566",
            "fax_number": "415-206-4153"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1450 Treat Blvd # 160",
            "address_purpose": "LOCATION",
            "city": "Walnut Creek",
            "state": "CA",
            "postal_code": "945972168",
            "country_code": "US",
            "telephone_number": "925-296-9000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPOONER",
        "first_name": "NICOLE",
        "middle_name": "ANASTASIA",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-10",
        "last_updated": "2018-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "755783",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95005748",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Spencer, RN, PHN
• Stephen Martin Sperber, LMFT
• Simona Spiegel
• Spinal Sattva, Inc
• Ronald Spinka, M.D.
• Nina P Sprecher, MFT
• Norma Springsteen
• Elizabeth Anne Davies Spurlock, LAC
• Gurpreet Kaur Srai, PHARMD
• Sarah Lewis Stadler, M.D.

• Family Nurse Practitioner in Berkeley, CA
• Providers in Berkeley, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2018; 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.