Scott Spencer

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704354457 Issued in MI

Practice address

37304 Kings Hwy
Beaver Island, MI 49782-5134

Phone

(231) 448-2275

NPI assigned

Jun 20, 2022

Last updated

Jun 20, 2022By 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 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Interoperability endpoints

• Direct secure messaging: scott.spencer.1@28492.direct.athenahealth.com

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

{
    "created_epoch": "1655683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655683200000",
    "number": "1669103800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9058 S TOTTENHAM DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496858569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37304 KINGS HWY",
            "city": "BEAVER ISLAND",
            "state": "MI",
            "postal_code": "497825134",
            "telephone_number": "231-448-2275"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9058 S Tottenham Dr",
            "address_purpose": "LOCATION",
            "city": "Traverse City",
            "state": "MI",
            "postal_code": "496858569",
            "country_code": "US",
            "telephone_number": "231-590-1512",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPENCER",
        "first_name": "SCOTT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-20",
        "last_updated": "2022-06-20",
        "certification_date": "2022-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704354457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://www.biruralhealth.org",
            "affiliation": "Y",
            "affiliationName": "Beaver Island Rural Health Center",
            "address_1": "37304 Kings Hwy",
            "city": "Beaver Island",
            "state": "MI",
            "country_code": "US",
            "postal_code": "497825134",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Beaver Island EMS
• Beaver Island Rural Health Center
• Courtney Deruiter, RDH
• Amanda Tiffany McGee, NP-C
• Susan Jane Solle, FNPC
• Wendy Sue White, DDS
• Kimberly Elizabeth Wysocki, PA

• Family Nurse Practitioner in Beaver Island, MI
• Providers in Beaver Island, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2022; 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.