Active NPI
Spencer Gines
- Nurse Practitioner
- Waterford, MI
National Provider Identifier
1821776576
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 343934
- Practice address
- 279 Summit Dr
Waterford, MI 48328-3364 - Phone
- (248) 745-4900
- NPI assigned
- Jul 11, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 343934 | AZ | Primary |
| General Practice Registered Nurse | 163WG0000X | 4704398546 | MI |
Addresses
Primary practice location
279 Summit Dr
Waterford, MI 48328-3364
Mailing address
279 Summit Dr
Waterford, MI 48328-3364
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704398546 | MI | MD | General Practice Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1689033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1789084800000",
"number": "1821776576",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "279 SUMMIT DR",
"city": "WATERFORD",
"state": "MI",
"postal_code": "483283364"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "279 SUMMIT DR",
"city": "WATERFORD",
"state": "MI",
"postal_code": "483283364",
"telephone_number": "248-745-4900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GINES",
"first_name": "SPENCER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-07-11",
"last_updated": "2026-09-11",
"certification_date": "2026-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "AZ",
"license": "343934",
"primary": true
},
{
"code": "163WG0000X",
"taxonomy_group": "",
"desc": "Registered Nurse, General Practice",
"state": "MI",
"license": "4704398546",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waterford, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.