Individual provider Active NPI

Spencer Simpson

  • Primary Care Nurse Practitioner
  • Portage, IN
National Provider Identifier
1740872746
Registry record updated Feb 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
209022630 Issued in IL
Practice address
6050 Sterling Creek Rd
Portage, IN 46368-7752
Phone
(219) 763-8112
NPI assigned
Feb 10, 2021
Last updated
Feb 10, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 209022630 IL Primary

Addresses

Primary practice location

6050 Sterling Creek Rd
Portage, IN 46368-7752

Mailing address

231 Spruce St
Momence, IL 60954-1069
Phone (815) 351-4153

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20210416001551 IN Order and Referring Only - Nurse Practitioner 5395153043

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing

State licenses

LicenseStateTypeSpecialty
209022630ILMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northshore Health Centers, Inc. Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: spencer.simpson.p1@direct.northshorehealth.nextgenshare.com

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1612915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612915200000",
    "number": "1740872746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "231 SPRUCE ST",
            "city": "MOMENCE",
            "state": "IL",
            "postal_code": "609541069",
            "telephone_number": "815-351-4153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6050 STERLING CREEK RD",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463687752",
            "telephone_number": "219-763-8112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMPSON",
        "first_name": "SPENCER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-10",
        "last_updated": "2021-02-10",
        "certification_date": "2021-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "IL",
            "license": "209022630",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, IN

Sources for this page

Verify at the official NPI Registry.