Active NPI
Derek E Spencer, CRNP
- Nurse Practitioner
- Baltimore, MD
National Provider Identifier
1972776995
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- R108156
- Practice address
- 22 S Greene St
Baltimore, MD 21201-1544 - Phone
- (410) 706-1661
- NPI assigned
- Apr 10, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | R108156 | MD | Primary |
Addresses
Primary practice location
22 S Greene St
Baltimore, MD 21201-1544
Mailing address
PO Box 64442
Baltimore, MD 21264-4442
Phone (410) 328-5793
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 947321-01 & 02 | Other | MD | BC/BS |
| S062-0348 | Other | MD | BC/BS REGIONAL |
| 416806200 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R108156 | MD | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1247702400000",
"number": "1972776995",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 64442",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212644442",
"telephone_number": "410-328-5793"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22 S GREENE ST",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212011544",
"telephone_number": "410-706-1661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPENCER",
"first_name": "DEREK",
"middle_name": "E",
"credential": "CRNP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-04-10",
"last_updated": "2009-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MD",
"license": "R108156",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "947321-01 & 02",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS REGIONAL",
"identifier": "S062-0348",
"state": "MD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "416806200",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.