Individual provider Active NPI

Justin Edward Sperlbaum, APRN

  • Nurse Practitioner
  • Pensacola, FL
National Provider Identifier
1669211652
Registry record updated May 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
11032778 Issued in FL
Practice address
1619 Creighton Rd Ste 2
Pensacola, FL 32504-7152
Phone
(850) 444-4700
NPI assigned
May 21, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 11032778 FL Primary

Addresses

Primary practice location

1619 Creighton Rd Ste 2
Pensacola, FL 32504-7152

Mailing address

1619 Creighton Rd Ste 2
Pensacola, FL 32504-7152
Phone (360) 471-4556

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240620000395 FL Practitioner - Nurse Practitioner 5799228672 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pensacola Nephrology PAGroup PAC ID 7214832856, 37 clinicians

Practice addresses (Care Compare)

1619 Creighton Rd
Suite 1
Pensacola, FL 32504-7152
Phone (850) 444-4700

Hospital & facility affiliations

  • Sacred Heart Hospital Hospital, Pensacola, FL, CCN 100025

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11032778FLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pensacola Nephrology, PA CurrentSince Jul 22, 2024 Accepting new patients
Pensacola Nephrology, PA CurrentSince Jul 22, 2024 Accepting new patients
Pensacola Nephrology, PA Past Accepting new patients

Locations

6001 Industrial Blvd
Century, FL 32535
Phone (251) 943-2300

221 E Redstone Ave
Crestview, FL 32539
Phone (850) 398-6606

319 Green Acres Rd
#103
Fort Walton Beach, FL 32547

1619 Creighton Rd
Ste 1
Pensacola, FL 32504
Phone 85044447001730

5149 N 9th Ave
Ste G35
Pensacola, FL 32504
Phone (850) 471-1445

2940 N Blue Angel Pkwy
Pensacola, FL 32506
Phone (850) 453-3658

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1716249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716249600000",
    "number": "1669211652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1619 CREIGHTON RD STE 2",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325047152",
            "telephone_number": "360-471-4556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1619 CREIGHTON RD STE 2",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325047152",
            "telephone_number": "850-444-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPERLBAUM",
        "first_name": "JUSTIN",
        "middle_name": "EDWARD",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-21",
        "last_updated": "2024-05-21",
        "certification_date": "2024-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "11032778",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pensacola, FL

Sources for this page

Verify at the official NPI Registry.