Individual provider Active NPI

Jordan Smith, D.O.

  • Surgery Physician
  • Moses Lake, WA
National Provider Identifier
1023464609
Registry record updated May 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
OP61146174 Issued in WA
Practice address
1550 S Pioneer Way
Moses Lake, WA 98837-4613
Phone
(509) 793-9792
Fax
(509) 764-3287
NPI assigned
May 12, 2016
Last updated
May 4, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 4, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X OP61146174 WA Primary

Addresses

Primary practice location

1550 S Pioneer Way
Moses Lake, WA 98837-4613

Mailing address

1616 S Pioneer Way
Moses Lake, WA 98837-2487
Phone (509) 793-9715

Other identifiers 1

IdentifierTypeStateIssuer
2181923MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jsmith1770707@wm.providencedirect.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210909003418 WA Practitioner - General Surgery 9133525504 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Midwestern University, Chicago College of Osteopathic Med, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1550 S Pioneer Way
Moses Lake, WA 98837-4613
Phone (509) 793-9780

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Grant County Public Hospital District 1 CurrentSince Sep 1, 2021 Accepting new patients
Grant County Public Hospital District 1 CurrentSince Sep 1, 2021 Accepting new patients
Grant County Public Hospital District 1 Current Accepting new patients
Grant County Public Hospital District 1 Past Accepting new patients

Locations

1550 S Pioneer Way
Moses Lake, WA 98837
Phone (509) 793-9780

1550 S Pioneer Way
Ste 305
Moses Lake, WA 98837

1616 S Pioneer Way
Moses Lake, WA 98837

2000 S Clover Dr
Moses Lake, WA 98837
Phone (509) 765-5606

660 S Coolidge St
Moses Lake, WA 98837

801 E Wheeler Rd
Moses Lake, WA 98837
Phone (509) 765-5606

8420 Aspi Blvd
Moses Lake, WA 98837
Phone (509) 793-9781

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1463011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777852800000",
    "number": "1023464609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1616 S PIONEER WAY",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988372487",
            "telephone_number": "509-793-9715",
            "fax_number": "509-764-3244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 S PIONEER WAY",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988374613",
            "telephone_number": "509-793-9792",
            "fax_number": "509-764-3287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JORDAN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-12",
        "last_updated": "2026-05-04",
        "certification_date": "2026-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WA",
            "license": "OP61146174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2181923",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jsmith1770707@wm.providencedirect.org",
            "affiliation": "N",
            "endpointDescription": "EPIC   EHR",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1550 S Pioneer Way",
            "city": "Moses Lake",
            "state": "WA",
            "country_code": "US",
            "postal_code": "988374613",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Moses Lake, WA

Sources for this page

Verify at the official NPI Registry.