Kristen Michelle Smith, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

121364 Issued in MA

Practice address

1 Boston Medical Ctr PL
Boston, MA 02118-2908

Phone

(617) 414-5245

Fax

(617) 414-5520

NPI assigned

Jul 1, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Kristen Michelle Jacques Other name

Medicare fee-for-service enrollment

Enrolled in MA

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

Specialty

Clinical Social Worker

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Southcoast Physicians Group IncGroup PAC ID 0749171957, 875 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Southcoast Hospitals Group Hospital, Fall River, MA, CCN 220074

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Southcoast Physicians Group, Inc.

  • Family Medicine Physician
  • Fairhaven, MA
  • NPI 1336137629
  Medicare reassignment Care Compare group NPD
• Tmin Services, Inc.

  • Community/Behavioral Health Agency
  • Burlington, MA
  • NPI 1225734262
  Medicare reassignment NPD
• Southcoast Physicians Group, Inc.

  • Orthopaedic Surgery Physician
  • North Dartmouth, MA
  • NPI 1902201536
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Southcoast Hospitals Group, Inc

  • General Acute Care Hospital
  • Wareham, MA
  • NPI 1922024835
  Care Compare affiliation

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

{
    "created_epoch": "1309478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712707200000",
    "number": "1013204767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 MASSACHUSETTS AVE",
            "address_2": "FL 2",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BOSTON MEDICAL CTR PL",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182908",
            "telephone_number": "617-414-5245",
            "fax_number": "617-414-5520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KRISTEN",
        "middle_name": "MICHELLE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-01",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "217194",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "121364",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110146704A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTEN",
            "last_name": "JACQUES",
            "middle_name": "MICHELLE",
            "credential": "LCSW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kelly B Smith, MA
• Kendall Smith, MD
• Kimberly Smith, NP-C
• Kirby Elizabeth Smith, PT, DPT
• Kori L Smith, PA
• Kylie Smith, DPT
• Lacey Smith, MS, CGC
• Lara Enid Smith, MD
• Laura Smith
• Laura Elizabeth Smith, M.D.

• Clinical Social Worker in Boston, MA
• Providers in Boston, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.