Basic Information
Provider Information | |||||||||
NPI: | 1699704213 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SPEARMAN | ||||||||
FirstName: | JAMES | ||||||||
MiddleName: | DAVID | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2880 TRICOM ST | ||||||||
Address2: |   | ||||||||
City: | NORTH CHARLESTON | ||||||||
State: | SC | ||||||||
PostalCode: | 294069171 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8437975050 | ||||||||
FaxNumber: | 8437973633 | ||||||||
Practice Location | |||||||||
Address1: | 2880 TRICOM ST | ||||||||
Address2: |   | ||||||||
City: | NORTH CHARLESTON | ||||||||
State: | SC | ||||||||
PostalCode: | 294069171 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8437975050 | ||||||||
FaxNumber: | 8437973633 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/03/2006 | ||||||||
LastUpdateDate: | 03/11/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/11/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | 16379 | SC | Y |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207X00000X | 16379 | SC | N |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 163799 | 05 | SC |   | MEDICAID | 1326287434 | 01 | SC | MEDICAID DME NPI | OTHER | 20076508 | 01 | SC | SELECT HEALTH DME | OTHER | 570634057 | 01 | SC | TAX ID | OTHER | 621997 | 01 | SC | SELECT HLTH | OTHER | 200024309 | 01 | SC | RRMCARE | OTHER |