Spora Medical, PC.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

SPORA MEDICAL, PC.

Practice address

4445 Corporation LN Ste 264
Virginia Beach, VA 23462-3262

Phone

(773) 389-1899

NPI assigned

May 5, 2020

Organization subpart

Yes

Parent organization

SPORA HEALTH, INC.As reported in NPPES

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

Authorized official

Name

Lakisa Davis

Title

Com

Phone

(773) 389-1899

Specialties & licenses 5

Addresses

Other identifiers 2

Part of

Spora Health LLC

Locations

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

{
    "created_epoch": "1588636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654646400000",
    "number": "1861013583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4445 CORPORATION LN STE 264",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234623262",
            "telephone_number": "773-389-1899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4445 CORPORATION LN STE 264",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234623262",
            "telephone_number": "773-389-1899"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "382 NE 191st St",
            "address_purpose": "LOCATION",
            "city": "Miami",
            "state": "FL",
            "postal_code": "331793899",
            "country_code": "US",
            "telephone_number": "773-389-1899",
            "fax_number": "773-466-9777",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "750 N Saint Paul St Ste 250",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752013206",
            "country_code": "US",
            "telephone_number": "773-389-1899",
            "fax_number": "773-466-9777",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9456 State Rd Ste 11-V490",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191143079",
            "country_code": "US",
            "telephone_number": "773-389-1899",
            "fax_number": "773-466-9777",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9234 Kingston Pike",
            "address_purpose": "LOCATION",
            "city": "Knoxville",
            "state": "TN",
            "postal_code": "379222380",
            "country_code": "US",
            "telephone_number": "773-389-1899",
            "fax_number": "773-466-9777",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "548 Market St",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941045401",
            "country_code": "US",
            "telephone_number": "773-389-1899",
            "fax_number": "773-466-9777",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SPORA MEDICAL, PC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPORA HEALTH, INC.",
        "enumeration_date": "2020-05-05",
        "last_updated": "2022-06-08",
        "certification_date": "2022-06-08",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "LAKISA",
        "authorized_official_title_or_position": "COM",
        "authorized_official_telephone_number": "773-389-1899"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "374J00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Doula",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1922695949",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1346993029",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicole Spencer, CCC-SLP
• Noah William Lee Spencer, RBT
• Rebecca Spencer
• Deja Isabella Spikes, MSW
• Zachary Thomas Splinter, PT, DPT, MS
• Spora Medical, PC.
• Sportsmed, P.C.
• Amber Sprayberry
• Joy J Sprenkle
• Spring Start ABA LLC

• Primary Care Clinic/Center in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Primary Care Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.