Justin Kuhns Spooner, MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

ME115625 Issued in FL

Practice address

230 Canal Blvd Ste 2
Ponte Vedra Beach, FL 32082-3745

Phone

(904) 280-6701

Fax

(904) 280-6702

NPI assigned

Nov 21, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 1, 2023 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14032/brand/1/csg/1/fhir/r4

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.

• Ponte Vedra Psychiatry LLC

  • Child & Adolescent Psychiatry Physician
  • Ponte Vedra Beach, FL
  • NPI 1366158883
  NPD Authorized official
• Omega Health and Nutrition LLC

  • Nutritionist
  • Jacksonville, FL
  • NPI 1134619208
  NPD (past)

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

{
    "created_epoch": "1195603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1720269459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 CANAL BLVD STE 2",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320823745",
            "telephone_number": "904-280-6701",
            "fax_number": "904-280-6702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 CANAL BLVD STE 2",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320823745",
            "telephone_number": "904-280-6701",
            "fax_number": "904-280-6702"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1351 13th Ave S Ste 120",
            "address_purpose": "LOCATION",
            "city": "Jacksonville Beach",
            "state": "FL",
            "postal_code": "322503237",
            "country_code": "US",
            "telephone_number": "904-280-6701",
            "fax_number": "904-280-6702",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2550 Park St",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "32204",
            "country_code": "US",
            "telephone_number": "904-280-6701",
            "fax_number": "904-280-6702",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2550 Park St",
            "address_2": "Ste B",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322044518",
            "country_code": "US",
            "telephone_number": "904-280-6701",
            "fax_number": "904-280-6702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPOONER",
        "first_name": "JUSTIN",
        "middle_name": "KUHNS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-21",
        "last_updated": "2023-03-07",
        "certification_date": "2023-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME115625",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "FL",
            "license": "ME115625",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "FL",
            "license": "ME115625",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0086324100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "HG956",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Child & Adolescent Psychiatry Physician in Ponte Vedra Beach, FL
• Providers in Ponte Vedra Beach, FL by specialty
• Child & Adolescent Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.