Donald Bruce Spradlin, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-04058 Issued in NC

Practice address

33270 US Hwy 264
Box 277
Engelhard, NC 27824

Phone

(252) 925-7000

Fax

(252) 925-7700

NPI assigned

Mar 6, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Elk River Physicians Group, PLLC

  • Podiatrist
  • Winchester, TN
  • NPI 1386686806
  NPD (past)

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

{
    "created_epoch": "1141603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393804800000",
    "number": "1659348951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33270 US HIGHWAY 264",
            "city": "ENGELHARD",
            "state": "NC",
            "postal_code": "278240277",
            "telephone_number": "252-925-7000",
            "fax_number": "252-925-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33270 US HWY 264",
            "address_2": "BOX 277",
            "city": "ENGELHARD",
            "state": "NC",
            "postal_code": "27824",
            "telephone_number": "252-925-7000",
            "fax_number": "252-925-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPRADLIN",
        "first_name": "DONALD",
        "middle_name": "BRUCE",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-06",
        "last_updated": "2014-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-04058",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "PA000503",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1659348951",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Beacon Comprehensive Services LLC
• Sally Carson Messick, FNP
• Ocracoke Health Center, Inc.
• Ocracoke Health Center, Inc.
• Thao Kim Pham, PA-C

• All providers in Engelhard, NC
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.