NPIMap

Individual provider Active NPI

Darice R Spackman, PAC ATC

  • Physician Assistant
  • Nashville, TN
National Provider Identifier
1689656910
Registry record updated Jan 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA 949 Issued in TN
Practice address
330 22ND Ave N
Nashville, TN 37203-1844
Phone
(615) 320-0007
Fax
(615) 320-0009
NPI assigned
Nov 14, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA 949 TN Primary
Surgical Physician Assistant 363AS0400X 949 TN

Addresses

Primary practice location

330 22ND Ave N
Nashville, TN 37203-1844

Mailing address

330 22ND Ave N
Nashville, TN 37203-1844
Phone (615) 320-0007

Other identifiers 3

IdentifierTypeStateIssuer
4166893OtherTNBCBS
4193033OtherTNBCBS ASSISTANT AT SURGERY
1504589MedicaidTN

Other names 1

  • Ms. Darice R Jenkins Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041014000936 TN Practitioner - Physician Assistant 9436119310 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Neurosurgical AssociatesGroup PAC ID 8022099142, 27 clinicians

Practice addresses (Care Compare)

2400 Patterson St
Suite 319
Nashville, TN 37203-1566
Phone 6159861256118

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
949TNMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Neurosurgical Associates Physician Assistant CurrentSince Apr 1, 2015 Accepting new patients
Nashville Neurosurgery Group, PLC PastSince Dec 1, 2014 Accepting new patients
HW Neurological Institute, LLC Past Accepting new patients

Locations

2400 Patterson St
Ste 319
Nashville, TN 37203

330 22nd Ave N
Nashville, TN 37203
Phone (615) 320-0007

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1131926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421971200000",
    "number": "1689656910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 22ND AVE N",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372031844",
            "telephone_number": "615-320-0007",
            "fax_number": "615-320-0009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 22ND AVE N",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372031844",
            "telephone_number": "615-320-0007",
            "fax_number": "615-320-0009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPACKMAN",
        "first_name": "DARICE",
        "middle_name": "R",
        "name_prefix": "Mrs.",
        "credential": "PAC ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-14",
        "last_updated": "2015-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "PA 949",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TN",
            "license": "949",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4166893",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ASSISTANT AT SURGERY",
            "identifier": "4193033",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1504589",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DARICE",
            "last_name": "JENKINS",
            "middle_name": "R",
            "prefix": "MS.",
            "credential": "PAC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Nashville, TN

Sources for this page

Verify at the official NPI Registry.