Individual provider Active NPI

William D Smith Jr., CRNA

  • Certified Registered Nurse Anesthetist
  • Shelbyville, KY
National Provider Identifier
1013092808
Registry record updated Apr 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
3002895 Issued in KY
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

Updated by the provider on Apr 10, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
200902460AMedicaidIN
7100045920MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170124001786 WV Practitioner - Certified Registered Nurse Anesthetist (Crna) 8224933411 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
3002895KYMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Medstream Anesthesia PLLC Nurse Anesthetist, Certified Registered CurrentSince Dec 19, 2016 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.

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.

Verify at the official NPI Registry.