NPIMap

Individual provider Active NPI

Jason Chauncey Spencer, PA-C

  • Physician Assistant
  • Jacksonville, FL
National Provider Identifier
1700995354
Registry record updated Jun 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9103004 Issued in FL
Practice address
8761 Perimeter Park Blvd Ste 106
Jacksonville, FL 32216-6397
Phone
(904) 621-6628
Fax
(904) 346-0113
NPI assigned
Aug 29, 2006
Last updated
Jun 11, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2008

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 003768 GA
Physician Assistant 363A00000X PA9103004 FL Primary

Addresses

Primary practice location

8761 Perimeter Park Blvd Ste 106
Jacksonville, FL 32216-6397

Mailing address

28 Yachtsmen Court
Woodbine, GA 31569
Phone (912) 541-0243

Other identifiers 3

IdentifierTypeStateIssuer
100002298DMedicaidGA
100002298FMedicaidGA
10059208OtherGAAMERIGROUP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, FL, NY3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20040227000464 GA Practitioner - Physician Assistant 5395631030 Reassigns benefits to 14 organizations
I20051210000029 FL Practitioner - Physician Assistant 5395631030 Reassigns benefits to 1 organization
I20200312001083 NY Practitioner - Physician Assistant 5395631030 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southland Hawkinsville Emergency Medical Services, LLCGroup PAC ID 2769600642, 13 clinicians
Jasper Health Services Inc.Group PAC ID 7214901230, 8 clinicians

Practice addresses (Care Compare)

222 Perry Hwy
Hawkinsville, GA 31036-6748
Phone (229) 200-4950

898 A College St
Monticello, GA 31064-1258

898 College St
Monticello, GA 31064-1258
Phone (706) 468-0988

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3768GAMDOptometrist
003768GAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Southland Taylor Hospitalist Group, LLC CurrentSince Nov 1, 2025 Accepting new patients
Georgia Em-I Medical Services, LLC Physician Assistant CurrentSince May 1, 2016 Accepting new patients
Jasper Health Services Inc. CurrentSince May 18, 2025 Accepting new patients
Houston County Emergency Group, LLC CurrentSince Jan 1, 2019 Accepting new patients
Houston Hospitalist Group LLC CurrentSince Oct 1, 2020 Accepting new patients
Nes Medical Services of New York PC CurrentSince Jan 29, 2020 Accepting new patients
Southland Hawkinsville Emergency Medical Services, LLC CurrentSince Nov 1, 2025 Accepting new patients
Advanced Pediatric Specialists LLC Past Accepting new patients
A Gold Coast Foot Clinic, LTD. Past Accepting new patients

Locations

3651 Wheeler Rd
Augusta, GA 30909
Phone (706) 651-2369

1500 E Shotwell St
Bainbridge, GA 39819
Phone (229) 243-6100

5126 Hospital Dr NE
Covington, GA 30014
Phone (770) 385-4340

222 Perry Hwy
Hawkinsville, GA 31036
Phone (229) 200-4950

898 College St
Monticello, GA 31064
Phone (706) 468-0988

11 Upper Riverdale Rd SW
Riverdale, GA 30274
Phone (770) 897-7277

915 Gordon Ave
Thomasville, GA 31792
Phone (229) 228-8575

1601 Watson Blvd
Warner Robins, GA 31093
Phone (478) 322-5155

7571 State Route 54
Bath, NY 14810
Phone (607) 776-8500

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

Organizations & group practices 23

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.

View all 23

Hospital & facility affiliations 4

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": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213142400000",
    "number": "1700995354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 YACHTSMEN COURT",
            "city": "WOODBINE",
            "state": "GA",
            "postal_code": "31569",
            "telephone_number": "912-541-0243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8761 PERIMETER PARK BLVD STE 106",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322166397",
            "telephone_number": "904-621-6628",
            "fax_number": "904-346-0113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPENCER",
        "first_name": "JASON",
        "middle_name": "CHAUNCEY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2008-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "003768",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9103004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100002298D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100002298F",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "10059208",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.