Jordan M Spencer, DO

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

52045 Issued in SC

Practice address

171 Ashley Ave
Charleston, SC 29425-0100

Phone

(843) 792-0192

NPI assigned

Jun 23, 2018

Last updated

Mar 21, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MD, DC2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Axis Healthcare Group

  dba CareMind Health

  • Psychiatry Physician
  • Silver Spring, MD
  • NPI 1326295098

  DC

  Medicare reassignment NPD
• Barrier Islands Psychiatry P a

  • Psychiatry Physician
  • Charleston, SC
  • NPI 1952517229
  NPD (past)
• MCS, PC

  dba Mindoula Health, Inc.

  • Community/Behavioral Health Agency
  • Silver Spring, MD
  • NPI 1538717723

  Psychiatry

  NPD (past)

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

{
    "created_epoch": "1529712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710979200000",
    "number": "1851886782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 PRESIDENT ST",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294255712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 ASHLEY AVE",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294250100",
            "telephone_number": "843-792-0192"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 E Carroll St",
            "address_purpose": "LOCATION",
            "city": "Salisbury",
            "state": "MD",
            "postal_code": "218015422",
            "country_code": "US",
            "telephone_number": "202-360-4787",
            "fax_number": "202-360-4787",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPENCER",
        "first_name": "JORDAN",
        "middle_name": "M",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-23",
        "last_updated": "2024-03-21",
        "certification_date": "2023-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "LL52045",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "SC",
            "license": "52045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Dawn Spencer, FNP
• Bettie J Spencer, CRNA
• Caleb Spencer, ATC
• Deborah Vinson Spencer, M.D.
• Jack Christopher Spencer, MD
• Nathaniel Andrew Spencer, D.O.
• Susan X Spencer
• Patricia Spens
• John B Sperry Jr., M.D.
• Elizabeth Grace Spicer, DNP

• Psychiatry Physician in Charleston, SC
• Providers in Charleston, SC by specialty
• Psychiatry Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.