Carole Suzanne Lucie Spake, MD

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

LP05684 Issued in RI

Practice address

593 Eddy St
Providence, RI 02903-4923

Phone

(401) 444-4000

NPI assigned

Apr 10, 2021

Sex

Female

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 RI

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1618012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655078400000",
    "number": "1932789385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "389 BENEFIT ST APT 2",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029032945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "401-444-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "389 Benefit St Apt 2",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029032945",
            "country_code": "US",
            "telephone_number": "401-855-4472",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPAKE",
        "first_name": "CAROLE",
        "middle_name": "SUZANNE LUCIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-10",
        "last_updated": "2022-06-13",
        "certification_date": "2022-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "RI",
            "license": "LP05684",
            "primary": true
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "RI",
            "license": "LP05684",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Ann Souza
• Monica Katharine Souza, PA-C
• Nicholas Joseph Souza, LPN
• Stacie Lyn Souza, LICSW
• Victoria Souza, PHARMD
• Anthony Joseph Spallino, PA-C
• Lora Spalt, LCDS
• Partaja Niqua Spann Taylor, LCSW
• Erica Spano, FNP-C
• Coco Sparks, RDN, LDN

• Student in an Organized Health Care Education/Training Program in Providence, RI
• Providers in Providence, RI by specialty
• Student in an Organized Health Care Education/Training Program in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2022; 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.