Individual provider Active NPI

Matthew Cory Spence, M.D.

  • Pediatric Critical Care Medicine Physician
  • Minneapolis, MN
National Provider Identifier
1902337447
Registry record updated Apr 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
76557 Issued in MN
Practice address
2530 Chicago Ave Ste 400
Minneapolis, MN 55404-4387
Phone
(612) 813-3300
Fax
(612) 813-3349
NPI assigned
Mar 26, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 303481 NY
Pediatrics Physician 208000000X 76557 MN
Pediatric Critical Care Medicine Physician 2080P0203X 76557 MN Primary

Addresses

Primary practice location

2530 Chicago Ave Ste 400
Minneapolis, MN 55404-4387

Mailing address

2530 Chicago Ave Ste 400
Minneapolis, MN 55404-4387
Phone (612) 813-3300

Other practice location 1

111 E 210th St
Bronx, NY 10467-2401
Phone (718) 741-2460

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, MN2 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

Enrollment IDStateProvider typePAC IDDetails
I20200820003550 NY Practitioner - Pediatric Medicine 7810313897 Reassigns benefits to 1 organization
I20240716003818 MN Practitioner - Pediatric Medicine 7810313897 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center Pediatrics CurrentSince Jun 19, 2020 Accepting new patients
Montefiore Medical Center CurrentSince Jun 19, 2020 Accepting new patients
Children'S Respiratory & Critical Care Specialists. P.a. Pediatrics CurrentSince Aug 1, 2024 Accepting new patients
Gillette Children'S Specialty Healthcare PastSince Apr 21, 2024 Accepting new patients
Childrens Health Care Past Accepting new patients

Locations

2530 Chicago Ave
Ste 400
Minneapolis, MN 55404
Phone (612) 813-3300

111 E 210th St
Bronx, NY 10467

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1490486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713312000000",
    "number": "1902337447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2530 CHICAGO AVE STE 400",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554044387",
            "telephone_number": "612-813-3300",
            "fax_number": "612-813-3349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 CHICAGO AVE STE 400",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554044387",
            "telephone_number": "612-813-3300",
            "fax_number": "612-813-3349"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 E 210th St",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104672401",
            "country_code": "US",
            "telephone_number": "718-741-2460",
            "fax_number": "718-654-6692",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPENCE",
        "first_name": "MATTHEW",
        "middle_name": "CORY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-26",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "303481",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "76557",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "MN",
            "license": "76557",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.