NPIMap

Organization Active NPI

Jacob a Spencer DO Inc

  • Orthopaedic Surgery Physician
  • Palm Desert, CA
National Provider Identifier
1558005355
Registry record updated Jun 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
JACOB A SPENCER DO INC
Practice address
36953 Cook St Ste 101
Palm Desert, CA 92211-6083
Phone
(760) 972-4580
Fax
(760) 972-4586
NPI assigned
Apr 27, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2023

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

Authorized official

Name
Jacob Spencer, DONPI 1346565793
Title
Owner
Phone
(760) 972-4580

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X Primary

Addresses

Primary practice location

36953 Cook St Ste 101
Palm Desert, CA 92211-6083

Mailing address

44489 Town Center Way Ste D482
Palm Desert, CA 92260-2723
Phone (760) 972-4580

Other practice location 1

79200 Corporate Center Dr Ste 104
LA Quinta, CA 92253-7245
Phone (760) 972-4580

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20230306001559 CA Part B Supplier - Clinic/Group Practice 7416320882 Receives reassigned benefits from 3 practitioners
Practice locations: La Quinta, CA; Palm Desert, CA
O20230920002706 CA DME Supplier - Physician - Orthopedic/Orthopedic Surgery 7416320882 Practice locations: Palm Desert, CA

National Provider Directory

National Provider Directory

Locations

79200 Corporate Center Dr
Ste 104
La Quinta, CA 92253
Phone (760) 424-5578

44489 Town Center Way
Ste D482
Palm Desert, CA 92260

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1651017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685836800000",
    "number": "1558005355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44489 TOWN CENTER WAY STE D482",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922602723",
            "telephone_number": "760-972-4580",
            "fax_number": "760-972-4586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36953 COOK ST STE 101",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922116083",
            "telephone_number": "760-972-4580",
            "fax_number": "760-972-4586"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "79200 Corporate Center Dr Ste 104",
            "address_purpose": "LOCATION",
            "city": "LA Quinta",
            "state": "CA",
            "postal_code": "922537245",
            "country_code": "US",
            "telephone_number": "760-972-4580",
            "fax_number": "760-972-4586",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JACOB A SPENCER DO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-27",
        "last_updated": "2023-06-04",
        "certification_date": "2023-06-04",
        "status": "A",
        "authorized_official_last_name": "SPENCER",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "760-972-4580",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Desert, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.