NPIMap

Individual provider Active NPI

Evan Spencer

  • Urology Physician
  • State College, PA
National Provider Identifier
1780215012
Registry record updated May 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
MD489904 Issued in PA
Practice address
164 Greenview Dr Ste 300
State College, PA 16803-2106
Phone
(814) 238-8418
Fax
(814) 234-2888
NPI assigned
Jan 27, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Urology Physician 208800000X MD489904 PA Primary

Addresses

Primary practice location

164 Greenview Dr Ste 300
State College, PA 16803-2106

Mailing address

155 Wellness Way
State College, PA 16803-6797
Phone (814) 231-7000

Other practice location 1

100 Woods Rd
Valhalla, NY 10595-1530
Phone (123) 345-6789

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20250604003824 PA Practitioner - Urology 3971012402 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mount Nittany Medical Center Health Services IncGroup PAC ID 8426136797, 366 clinicians
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians

Practice addresses (Care Compare)

164 Greenview Dr
State College, PA 16803-2106
Phone (844) 278-4600

2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238

Hospital & facility affiliations

  • Mount Nittany Medical Center Hospital, State College, PA, CCN 390268
  • Penn Highlands Dubois Hospital, Dubois, PA, CCN 390086
  • Penn Highlands Huntingdon Hospital, Huntingdon, PA, CCN 390056
  • Penn Highlands Elk Hospital, Saint Marys, PA, CCN 391315

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Mount Nittany Medical Center Health Services Inc Urology CurrentSince Jul 1, 2025 Accepting new patients
Mount Nittany Medical Center Health Services Inc PastSince Jun 3, 2025 Accepting new patients

Locations

141 Medical Park Ln
Bellefonte, PA 16823
Phone (814) 355-7322

164 Greenview Dr
Ste 300
State College, PA 16803
Phone (814) 238-8418

164 Greenview Dr
State College, PA 16803
Phone (814) 237-4321

155 Wellness Way
State College, PA 16803
Phone (800) 367-0179

1850 E Park Ave
Ste 201
State College, PA 16803
Phone (814) 234-8800

Organizations & group practices 2

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 46

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

View all 46

NPI Registry JSON

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

{
    "created_epoch": "1580083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748304000000",
    "number": "1780215012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 WELLNESS WAY",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168036797",
            "telephone_number": "814-231-7000",
            "fax_number": "814-231-7098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 GREENVIEW DR STE 300",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168032106",
            "telephone_number": "814-238-8418",
            "fax_number": "814-234-2888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Woods Rd",
            "address_purpose": "LOCATION",
            "city": "Valhalla",
            "state": "NY",
            "postal_code": "105951530",
            "country_code": "US",
            "telephone_number": "123-345-6789",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPENCER",
        "first_name": "EVAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-01-27",
        "last_updated": "2025-05-27",
        "certification_date": "2025-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "PA",
            "license": "MD489904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in State College, PA

Sources for this page

Verify at the official NPI Registry.