Active NPI
Johnny Dwayne Smith, D.O.
- Family Medicine Physician
- Buckhannon, WV
National Provider Identifier
1043239817
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 1672
- Practice address
- 11 N Locust St
Buckhannon, WV 26201-2231 - Phone
- (304) 472-1600
- Fax
- (304) 472-6055
- NPI assigned
- Jul 19, 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 1672 | WV | Primary |
Addresses
Primary practice location
11 N Locust St
Buckhannon, WV 26201-2231
Mailing address
11 N Locust St
Buckhannon, WV 26201-2231
Phone (304) 472-1600
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001721765 | Other | WV | MOUNTAIN STATE BCBS |
| WV01672 | Other | WV | HEALTH PLAN |
| 3810001252 | Medicaid | WV | |
| P00154078 | Other | WV | RAILROAD MEDICARE |
| 001721766 | Other | WV | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170926000754 | WV | Order and Referring Only - Family Practice | 9931160793 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1672 | WV | MD | School Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1414368000000",
"number": "1043239817",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 N LOCUST ST",
"city": "BUCKHANNON",
"state": "WV",
"postal_code": "262012231",
"telephone_number": "304-472-1600",
"fax_number": "304-472-6055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11 N LOCUST ST",
"city": "BUCKHANNON",
"state": "WV",
"postal_code": "262012231",
"telephone_number": "304-472-1600",
"fax_number": "304-472-6055"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "JOHNNY",
"middle_name": "DWAYNE",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-19",
"last_updated": "2014-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WV",
"license": "1672",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MOUNTAIN STATE BCBS",
"identifier": "001721765",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PLAN",
"identifier": "WV01672",
"state": "WV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3810001252",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00154078",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "001721766",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Buckhannon, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2014; 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.