Active NPI
Nicole Smith, PA
- Physician Assistant
- Bangor, MI
National Provider Identifier
1053941674
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601009812
- Practice address
- 520 Railroad St
Bangor, MI 49013-1490 - Phone
- (269) 427-5811
- NPI assigned
- Jan 23, 2020
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601009812 | MI | Primary |
Addresses
Primary practice location
520 Railroad St
Bangor, MI 49013-1490
Mailing address
601 John Street
Box 42
Kalamazoo, MI 49007
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | direct@direct.bronsonhg.org | Direct | Bronson Healthcare Group |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200219002687 | MI | Practitioner - Physician Assistant | 3971930546 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Bronson Lakeview Hospital
Practice addresses (Care Compare)
520 Railroad St
Bangor, MI 49013-1490
Phone (269) 427-5811
Hospital & facility affiliations
- Bronson South Haven Hospital
- Bronson Lakeview Hospital
- Bronson Methodist Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601009812 | MI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bronson Lakeview Hospital | Current | Accepting new patients | |
| Bronson Lakeview Hospital | Past | Accepting new patients |
Locations
520 Railroad St
Bangor, MI 49013
Phone (269) 427-5811
601 John St
#42
Kalamazoo, MI 49007
Phone (269) 341-7806
601 John St
Kalamazoo, MI 49007
Phone (269) 341-7100
451 Health Pkwy
Paw Paw, MI 49079
Phone (269) 655-1725
930 Blue Star Hwy
South Haven, MI 49090
Phone (269) 637-1115
Interoperability endpoints
- direct@direct.bronsonhg.org
Organizations & group practices 6
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.
-
- Rural Health Clinic/Center
- South Haven, MI
- NPI 1801538871
-
- Rural Health Clinic/Center
- Bangor, MI
- NPI 1104459627
-
- Rural Health Clinic/Center
- Paw Paw, MI
- NPI 1356565170
-
- Rural Health Clinic/Center
- Decatur, MI
- NPI 1376767285
-
- Critical Access Hospital
- Paw Paw, MI
- NPI 1962508259
Hospital & facility affiliations 3
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": "1579737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731283200000",
"number": "1053941674",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "601 JOHN STREET",
"address_2": "BOX 42",
"city": "KALAMAZOO",
"state": "MI",
"postal_code": "49007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "520 RAILROAD ST",
"city": "BANGOR",
"state": "MI",
"postal_code": "490131490",
"telephone_number": "269-427-5811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "NICOLE",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-01-23",
"last_updated": "2024-11-11",
"certification_date": "2024-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601009812",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "direct@direct.bronsonhg.org",
"affiliation": "Y",
"endpointDescription": "Bronson Healthcare Group Direct address",
"affiliationName": "Bronson Healthcare Group",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Continuity of Care Document",
"address_1": "601 John St",
"city": "Kalamazoo",
"state": "MI",
"country_code": "US",
"postal_code": "490075341",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Bangor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2024; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.