Sandra Smith

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

363LP2300X Issued in IN

Practice address

220 Clifty Dr Ste J
Madison, IN 47250-1669

Phone

(812) 274-0713

NPI assigned

Sep 18, 2014

Sex

Female

Sole proprietor

Yes

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 IN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• State of Indiana, Auditor of State

  dba Madison State Hospital

  • Psychiatric Hospital
  • Madison, IN
  • NPI 1700876224
  Medicare reassignment NPD
• Madison Healthcare and Wellness Ctr. PC

  • Primary Care Nurse Practitioner
  • Madison, IN
  • NPI 1891382057
  NPD Authorized official
• State of Indiana, Auditor of State

  dba Indiana Department of Health

  • Public Health or Welfare Agency
  • Indianapolis, IN
  • NPI 1023613403
  NPD
• State of Indiana, Auditor of State

  dba Madison State Hospital

  • Psychiatric Hospital
  • Madison, IN
  • NPI 1659497477
  NPD

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

{
    "created_epoch": "1410998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654732800000",
    "number": "1013319367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 CLIFTY DR STE J",
            "city": "MADISON",
            "state": "IN",
            "postal_code": "472501669",
            "telephone_number": "812-274-0713",
            "fax_number": "812-205-2970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 CLIFTY DR STE J",
            "city": "MADISON",
            "state": "IN",
            "postal_code": "472501669",
            "telephone_number": "812-274-0713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "SANDRA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-09-18",
        "last_updated": "2022-06-09",
        "certification_date": "2020-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "IN",
            "license": "363LP2300X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Diane Simpson-Pinkston, OTR/L
• Melvin J Skiles, M.D.
• William W Skiles, M.D.
• Bethany Smith
• Brandy J Smith, APRN
• Travis L Smith, CRNA
• Tristyn Cheyne Smolarczyk
• SN Kentuckiana Rehab, LLC (KORT Kids -Madison)
• SN Kentuckiana Rehab, LLC (KORT Kids -Madison)
• SN Kentuckiana Rehab, LLC (KORT Physical Therapy)

• Primary Care Nurse Practitioner in Madison, IN
• Providers in Madison, IN by specialty
• Primary Care Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.