Individual provider Active NPI

Spencer Poulson

  • Family Nurse Practitioner
  • St George, UT
National Provider Identifier
1942513916
Registry record updated Oct 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
8336759-4405 Issued in UT
Practice address
652 S Medical Center Dr # 420
St George, UT 84790-7049
Phone
(435) 251-6800
NPI assigned
Jul 20, 2010
Last updated
Oct 12, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 8336759-4405 UT Primary
Counselor 101Y00000X NU

Addresses

Primary practice location

652 S Medical Center Dr # 420
St George, UT 84790-7049

Mailing address

652 S Medical Center Dr # 420
St George, UT 84790-7049
Phone (435) 251-6800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201221002081 UT Practitioner - Nurse Practitioner 3779995485 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

652 S Medical Ctr Dr
Suite 420
St George, UT 84790-7049
Phone (435) 251-3700

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
8336759-4405UTMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services, Inc. CurrentSince Feb 1, 2021 Accepting new patients
Ihc Health Services Inc CurrentSince Feb 1, 2021 Accepting new patients
Ihc Health Services Inc Current Accepting new patients
Ihc Health Services Inc Past Accepting new patients

Locations

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

652 S Medical Center Dr
#420
St George, UT 84790
Phone (435) 251-6800

652 S Medical Center Dr
Ste 420
St George, UT 84790
Phone (435) 251-3700

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 3

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": "1279584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602460800000",
    "number": "1942513916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "652 S MEDICAL CENTER DR # 420",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847907049",
            "telephone_number": "435-251-6800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "652 S MEDICAL CENTER DR # 420",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847907049",
            "telephone_number": "435-251-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POULSON",
        "first_name": "SPENCER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-20",
        "last_updated": "2020-10-12",
        "certification_date": "2020-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "8336759-4405",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St George, UT

Sources for this page

Verify at the official NPI Registry.