Active NPI
Courtland Prentice Smith Jr., M.D.
- Otolaryngology Physician
- Afton, OK
National Provider Identifier
1043371198
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 25369
- Practice address
- 26300 South Hwy 125
Afton, OK 74331 - Phone
- (918) 257-8585
- Fax
- (918) 257-8560
- NPI assigned
- Dec 13, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 107833 | MO | |
| Otolaryngology Physician | 207Y00000X | 25369 | OK | Primary |
Addresses
Primary practice location
26300 South Hwy 125
Afton, OK 74331
Mailing address
26300 South Hwy 125
Afton, OK 74331
Phone (918) 257-8585
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 19859 | Other | MO | BLUE CROSS BLUE SHIELD |
| 207948209 | Medicaid | MO | |
| 128329001 | Medicaid | AR | |
| 97588 | Other | AR | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 107833 | MO | MD | Otolaryngology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ferguson Medical Group | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Sikeston, MO
- NPI 1205956661
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231113600000",
"number": "1043371198",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26300 SOUTH HWY 125",
"city": "AFTON",
"state": "OK",
"postal_code": "74331",
"telephone_number": "918-257-8585",
"fax_number": "918-257-8560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26300 SOUTH HWY 125",
"city": "AFTON",
"state": "OK",
"postal_code": "74331",
"telephone_number": "918-257-8585",
"fax_number": "918-257-8560"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "COURTLAND",
"middle_name": "PRENTICE",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-13",
"last_updated": "2009-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "MO",
"license": "107833",
"primary": false
},
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "OK",
"license": "25369",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "19859",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "207948209",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "128329001",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "97588",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Afton, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.