Individual provider Active NPI

Rebecca J. Smith, PA-C

  • Physician Assistant
  • O Fallon, MO
National Provider Identifier
1013030949
Registry record updated Mar 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2006013856 Issued in MO
Practice address
9209 Phoenix Village Pkwy
O Fallon, MO 63368-4280
Phone
(636) 561-4630
Fax
(636) 561-4610
NPI assigned
Apr 7, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2006013856 MO Primary

Addresses

Primary practice location

9209 Phoenix Village Pkwy
O Fallon, MO 63368-4280

Mailing address

801 York St
Manitowoc, WI 54220-4630
Phone (920) 663-7190

Other practice location 1

1800 Wentzville Pkwy
Wentzville, MO 63385-3817
Phone (636) 200-9220

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address Rebecca.Smith@forefrontdermatology.emadirect.md
Direct Messaging Address Rebecca.Smith@forefrontdermatology.emadirect.md

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20160512001709 MO Practitioner - Physician Assistant 4789648759 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Forefront Dermatology SCGroup PAC ID 3779471701, 650 clinicians

Practice addresses (Care Compare)

12855 N 40 Dr
Suite 180
Saint Louis, MO 63141-8657
Phone (314) 878-5599

1800 Wentzville Pkwy
Wentzville, MO 63385-3817
Phone (636) 200-9220

9209 Phoenix Village Pkwy
O Fallon, MO 63368-4280
Phone (636) 561-4613

Merit-based Incentive Payment System (MIPS)

Final score
97.45 of 100Reported as group
Promoting interoperability
97
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2006013856MOMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St. Louis Dermatology and Surgery Center, PC Current Accepting new patients
Forefront Dermatology, S.C. CurrentSince Feb 1, 2018 Accepting new patients
Forefront Dermatology, S.C. CurrentSince Feb 1, 2018 Accepting new patients
Forefront Dermatology, S.C. Past Accepting new patients

Locations

1223 Maple St
Farmington, MO 63640
Phone (573) 760-0091

9209 Phoenix Village Pkwy
O Fallon, MO 63368
Phone (636) 474-3376

12855 N 40 Dr
Ste 180
Saint Louis, MO 63141
Phone (314) 878-5599

1800 Wentzville Pkwy
Wentzville, MO 63385
Phone (636) 200-9220

801 York St
Manitowoc, WI 54220
Phone (866) 630-9882

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1175904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741910400000",
    "number": "1013030949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 YORK ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542204630",
            "telephone_number": "920-663-7190",
            "fax_number": "920-684-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9209 PHOENIX VILLAGE PKWY",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633684280",
            "telephone_number": "636-561-4630",
            "fax_number": "636-561-4610"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1800 Wentzville Pkwy",
            "address_purpose": "LOCATION",
            "city": "Wentzville",
            "state": "MO",
            "postal_code": "633853817",
            "country_code": "US",
            "telephone_number": "636-200-9220",
            "fax_number": "636-590-7659",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "REBECCA",
        "middle_name": "J.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-07",
        "last_updated": "2025-03-14",
        "certification_date": "2025-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2006013856",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Rebecca.Smith@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "9209 Phoenix Village Pkwy",
            "city": "O Fallon",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633684280",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Rebecca.Smith@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "1800 Wentzville Pkwy",
            "city": "Wentzville",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633853817",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in O Fallon, MO

Sources for this page

Verify at the official NPI Registry.