Individual provider Active NPI

Kara Leigh Smith

  • Clinical Social Worker
  • Venice, CA
National Provider Identifier
1003116781
Registry record updated Feb 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
100110 Issued in CA
Practice address
204 Hampton Dr
Venice, CA 90291-2623
Phone
(310) 396-6468
NPI assigned
Oct 27, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 100110 CA Primary
Mental Health Counselor 101YM0800X

Addresses

Primary practice location

204 Hampton Dr
Venice, CA 90291-2623

Mailing address

1801 E Wardlow Rd Apt 2
Long Beach, CA 90807-4957
Phone (323) 286-1016

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210309003179 CA Practitioner - Clinical Social Worker 0648686022 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
100110CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Cognitive Care Solutions Group Inc CurrentSince Feb 3, 2021 Accepting new patients
Cognitive Care Solutions Inc PastSince Jun 10, 2014 Accepting new patients

Locations

3943 Irvine Blvd
Irvine, CA 92602
Phone (714) 922-0120

23461 S Pointe Dr
Ste 240
Laguna Hills, CA 92653
Phone (714) 545-3390

1526 Brookhollow Dr
Ste 73
Santa Ana, CA 92705
Phone (714) 545-3390

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IFAJCD/Endpoint/IFAJCD
  • FHIR API: https://api.platform.athenahealth.com/15985/brand/2/csg/1/fhir/r4

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1288137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614211200000",
    "number": "1003116781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 E WARDLOW RD APT 2",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908074957",
            "telephone_number": "323-286-1016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 HAMPTON DR",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "902912623",
            "telephone_number": "310-396-6468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KARA",
        "middle_name": "LEIGH",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-27",
        "last_updated": "2021-02-25",
        "certification_date": "2021-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "100110",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Venice, CA

Sources for this page

Verify at the official NPI Registry.