Mitchell Wade Spencer, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

011824 Issued in AZ

Practice address

4530 E Ray Rd Ste 190
Phoenix, AZ 85044-6098

Phone

(808) 275-4204

NPI assigned

Apr 12, 2022

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 AZ

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, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Banner Primary Care Physicians Arizona LLCGroup PAC ID 6406020155, 236 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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.

• Banner Primary Care Physicians Arizona LLC

  • Primary Care Clinic/Center
  • Phoenix, AZ
  • NPI 1659640902
  Medicare reassignment Care Compare group NPD
• Banner Primary Care Physicians Arizona LLC

  • Primary Care Clinic/Center
  • Phoenix, AZ
  • NPI 1790306066
  NPD
• Banner Primary Care Physicians Arizona LLC

  • Primary Care Clinic/Center
  • Phoenix, AZ
  • NPI 1417238908
  NPD (past)

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

{
    "created_epoch": "1649721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757030400000",
    "number": "1649912387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4530 E RAY RD STE 190",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850446098",
            "telephone_number": "480-827-5420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4530 E RAY RD STE 190",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850446098",
            "telephone_number": "808-275-4204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPENCER",
        "first_name": "MITCHELL",
        "middle_name": "WADE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-12",
        "last_updated": "2025-09-05",
        "certification_date": "2025-09-05",
        "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": "AZ",
            "license": "011824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Spencer, CNM
• Christopher D Spencer
• Kimberli Mae Spencer, DNP, APRN, FNP
• Mackenzie Spencer, DO
• Marsha L S Spencer, PH.D.
• Nadezhda Spencer
• Paige Spencer, RN
• Riley Kyle Spencer, D.O.
• Ryan Spencer
• Sarah Spencer, NP

• Family Medicine Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2025; 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.