NPIMap

Individual provider Active NPI

Brian Sponseller, MD

  • Family Medicine Physician
  • North Conway, NH
National Provider Identifier
1891984647
Registry record updated Aug 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
14575 Issued in NH
Practice address
3073 White Mountain Hwy
North Conway, NH 03860-7101
Phone
(603) 356-5472
NPI assigned
Oct 17, 2007
Last updated
Aug 16, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2010

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2299-850 WI
Family Medicine Physician 207Q00000X 50976-20 WI
Family Medicine Physician 207Q00000X 14575 NH Primary

Addresses

Primary practice location

3073 White Mountain Hwy
North Conway, NH 03860-7101

Mailing address

PO Box 2540
North Conway, NH 03860-2540
Phone (603) 356-5472

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20180313002394 SC Practitioner - Family Practice 0446349476 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hartsville Medical Group LLCGroup PAC ID 7012062714, 78 clinicians

Practice addresses (Care Compare)

1304 W Bobo Newsom Hwy
Hartsville, SC 29550-4710
Phone (843) 878-1101

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
51896SCMDEmergency Medical Services (Emergency Medicine) Physician
2299-850WIMDFamily Medicine Physician
50976-20WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hartsville Medical Group LLC Family Medicine CurrentSince Feb 5, 2018 Accepting new patients
Hartsville, LLC Past Accepting new patients
MWV Health Care Assoc Past Accepting new patients
Realeyes Eye Care, LLC PastSince Aug 25, 2011 Accepting new patients

Locations

1304 W Bobo Newsom Hwy
Hartsville, SC 29550
Phone (469) 340-1366

700 Medical Park Dr
Hartsville, SC 29550
Phone (843) 383-3742

Interoperability endpoints

  • Direct secure messaging: brian.sponseller.1@8689.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/8689/brand/1/csg/1/fhir/r4

Organizations & group practices 4

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1192579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281916800000",
    "number": "1891984647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2540",
            "city": "NORTH CONWAY",
            "state": "NH",
            "postal_code": "038602540",
            "telephone_number": "603-356-5472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3073 WHITE MOUNTAIN HWY",
            "city": "NORTH CONWAY",
            "state": "NH",
            "postal_code": "038607101",
            "telephone_number": "603-356-5472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPONSELLER",
        "first_name": "BRIAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-17",
        "last_updated": "2010-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "2299-850",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "50976-20",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NH",
            "license": "14575",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Conway, NH

Sources for this page

Verify at the official NPI Registry.