Christopher Shane Smith

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

070.015326 Issued in IL

Practice address

1400 Midtown Road
Peru, IL 61354

Phone

(815) 223-8600

Fax

(815) 223-4667

NPI assigned

Dec 8, 2015

Last updated

Dec 8, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

West Tennessee Bone and Joint Clinic PCGroup PAC ID 7517940182, 64 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: christopher.smith.1@3533.direct.athenahealth.com

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.

• West Tennessee Bone and Joint Clinic PC

  • Specialist
  • Jackson, TN
  • NPI 1831312461

  Orthopedic

  Medicare reassignment Care Compare group NPD
• St. Margaret's Hospital

  dba SMH Granville Clinic

  • Rural Health Clinic/Center
  • Granville, IL
  • NPI 1497318299
  NPD (past)
• Lift Therapy, Inc.

  dba LIFT Therapy

  • Rehabilitation Clinic/Center
  • Jackson, TN
  • NPI 1114267986
  NPD (past)

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

{
    "created_epoch": "1449532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449532800000",
    "number": "1003281668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 MIDTOWN ROAD",
            "city": "PERU",
            "state": "IL",
            "postal_code": "61354",
            "telephone_number": "815-223-8600",
            "fax_number": "815-223-4667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 MIDTOWN ROAD",
            "city": "PERU",
            "state": "IL",
            "postal_code": "61354",
            "telephone_number": "815-223-8600",
            "fax_number": "815-223-4667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "CHRISTOPHER",
        "middle_name": "SHANE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-12-08",
        "last_updated": "2015-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "IL",
            "license": "070.015326",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Delinard Sibbaluca
• Moira Sibbaluca
• Katherine Elizabeth Siembab
• Spalding L Slevin IV, PT, CMPT
• Amy Lynn Smith, APN
• Luke Smith, PT
• Ryan Jeffrey Smith, D.C.
• Jens William Soderholm, DC
• Dawn Sorensen, RPH
• Veronica Spangler, FNP-C

• Orthopedic Physical Therapist in Peru, IL
• Providers in Peru, IL by specialty
• Orthopedic Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.