Active NPI
William D Smith Jr., CRNA
- Certified Registered Nurse Anesthetist
- Shelbyville, KY
National Provider Identifier
1013092808
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 3002895
- Practice address
- 727 Hospital Dr
Shelbyville, KY 40065-1660 - Phone
- (502) 647-4085
- Fax
- (502) 647-4098
- NPI assigned
- Oct 27, 2006
- 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 |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 3002895 | KY | Primary |
Addresses
Primary practice location
727 Hospital Dr
Shelbyville, KY 40065-1660
Mailing address
6801 Dixie Hwy
Suite 130
Louisville, KY 40258-3913
Phone (502) 647-4085
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200902460A | Medicaid | IN | |
| 7100045920 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3002895 | KY | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medstream Anesthesia PLLC | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| University Anesthesiology Associates PSC | Past | Accepting new patients |
Locations
1710 Harper Rd
Beckley, WV 25801
Phone (304) 252-0641
859 Alderson St
Williamson, WV 25661
Phone (304) 235-2500
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 and National Provider Directory roles.
-
- Anesthesiology Physician
- Richardson, TX
- NPI 1649616160
Nurse Anesthetist, Certified Registered, WV
-
- Anesthesiology Physician
- Louisville, KY
- NPI 1578516852
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161907200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365552000000",
"number": "1013092808",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6801 DIXIE HWY",
"address_2": "SUITE 130",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402583913",
"telephone_number": "502-647-4085",
"fax_number": "502-647-4098"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "727 HOSPITAL DR",
"city": "SHELBYVILLE",
"state": "KY",
"postal_code": "400651660",
"telephone_number": "502-647-4085",
"fax_number": "502-647-4098"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "WILLIAM",
"middle_name": "D",
"name_suffix": "Jr.",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-27",
"last_updated": "2013-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "KY",
"license": "3002895",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200902460A",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7100045920",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Shelbyville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.