Individual provider Active NPI

Terra Smith

  • Student in an Organized Health Care Education/Training Program
  • Bloomfield, CT
National Provider Identifier
1053893495
Registry record updated Sep 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
693 Bloomfield Avenue
Bloomfield, CT 06002
Phone
(860) 731-5522
Fax
(860) 731-5536
NPI assigned
Sep 1, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

693 Bloomfield Avenue
Bloomfield, CT 06002

Mailing address

995 Day Hill Road
Windsor, CT 06095
Phone (860) 731-5522

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20241030000444 MA Practitioner - Clinical Social Worker 2961935986 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
SB Transitional Sub LLCGroup PAC ID 7911315379, 70 clinicians

Practice addresses (Care Compare)

140 High St
Suite 230
Springfield, MA 01199-1006
Phone (508) 521-2200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
SB Transitional Sub, LLC CurrentSince Sep 9, 2024 Accepting new patients

Locations

103 Commercial St
Ste 2
Brockton, MA 02302

1115 W Chestnut St
Brockton, MA 02301
Phone (508) 559-0473

140 High St
Ste 230
Springfield, MA 01199
Phone (413) 495-1500

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.

NPI Registry JSON

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

{
    "created_epoch": "1535760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535760000000",
    "number": "1053893495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "995 DAY HILL ROAD",
            "city": "WINDSOR",
            "state": "CT",
            "postal_code": "06095",
            "telephone_number": "860-731-5522",
            "fax_number": "860-731-5536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "693 BLOOMFIELD AVENUE",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "06002",
            "telephone_number": "860-731-5522",
            "fax_number": "860-731-5536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "TERRA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-01",
        "last_updated": "2018-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomfield, CT

Sources for this page

Verify at the official NPI Registry.