Jeremy Dane Sporrong, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

20A13251 Issued in CA

Practice address

11234 Anderson St
Gme Office CSP 21005
Loma Linda, CA 92354-2804

Phone

(909) 558-6688

NPI assigned

May 23, 2012

Last updated

Aug 18, 2015By 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 CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Nevada Health Centers IncGroup PAC ID 7113835307, shared by 25 NPIs, 39 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/1566/brand/2/csg/41/fhir/r4
• Direct secure messaging: jeremy.sporrong.1@16501.direct.athenahealth.com
• Direct secure messaging: jeremy.sporrong.p1@direct.nevadahealthcenters.nextgenshare.com
• Direct secure messaging: jsporrong695173@direct.ochin.org

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.

• Family Health Centers of San Diego, Inc

  dba Logan Heights Family Health Center

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1447281936
  Medicare reassignment NPD
• Northeast Valley Health Corporation

  dba Van Nuys Adult Health Center

  • Federally Qualified Health Center (FQHC)
  • Van Nuys, CA
  • NPI 1629079009
  Medicare reassignment NPD
• Samuel Dixon Family Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Val Verde, CA
  • NPI 1154402675
  Medicare reassignment NPD
• Family Health Centers of San Diego, Inc

  dba Escondido Physical Health and Wellness

  • Federally Qualified Health Center (FQHC)
  • Escondido, CA
  • NPI 1356178180
  NPD
• Family Health Centers of San Diego, Inc

  dba Beach Area Family Health Center

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1386689701
  NPD
• Northeast Valley Health Corporation

  dba San Fernando Health Center

  • Federally Qualified Health Center (FQHC)
  • San Fernando, CA
  • NPI 1235130600
  NPD
• Northeast Valley Health Corporation

  dba SCV Dental and Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Santa Clarita, CA
  • NPI 1548960834
  NPD
• Nevada Health Centers Inc

  dba Cambridge Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Las Vegas, NV
  • NPI 1073688198
  NPD
• Nevada Health Centers, Inc

  dba Pahrump Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Pahrump, NV
  • NPI 1326872334
  NPD
• Nevada Health Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Carson City, NV
  • NPI 1679649487

  Family Medicine

  NPD
• De Craig Ranch, LLC

  dba Dignity Health-St. Rose Dominican Blue Diamond Campus

  • General Acute Care Hospital
  • Las Vegas, NV
  • NPI 1922542968
  NPD (past)
• Dignity Health

  dba St. Rose Dominican Hospital, Siena Campus

  • General Acute Care Hospital
  • Henderson, NV
  • NPI 1770626426
  NPD (past)

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

{
    "created_epoch": "1337731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439856000000",
    "number": "1639439656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 GATEWAY CENTER WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921024541",
            "telephone_number": "619-906-4623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11234 ANDERSON ST",
            "address_2": "GME OFFICE CSP 21005",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923542804",
            "telephone_number": "909-558-6688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPORRONG",
        "first_name": "JEREMY",
        "middle_name": "DANE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-23",
        "last_updated": "2015-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A13251",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nika Spencer, RN, AGNP CANDIDATE
• Rosemarie Spencer, NNP
• Gerald Randall Speyer, MFT
• Ronald Spier, DO
• Justin Charles Spooler, M.D.
• Jamie L Spotville
• Jennifer Banico Spurgeon, MPT
• Shreya Sreeram, MD
• Serena Roxane Srikureja, MD
• Wichit Srikureja, M.D.

• Family Medicine Physician in Loma Linda, CA
• Providers in Loma Linda, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2015; 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.