Individual provider Active NPI

Kevin Smith, M.D.

  • Hospitalist Physician
  • Tucson, AZ
National Provider Identifier
1063619849
Registry record updated Apr 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
71767 Issued in AZ
Practice address
5301 E Grant Rd
Tucson, AZ 85712-2805
Phone
(520) 324-5461
NPI assigned
Jun 27, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 2, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 71767 AZ
Pediatrics Physician 208000000X 71767 AZ
Hospitalist Physician 208M00000X 036.127672 IL
Hospitalist Physician 208M00000X 71767 AZ Primary

Addresses

Primary practice location

5301 E Grant Rd
Tucson, AZ 85712-2805

Mailing address

2157 W Concord PL
Apt 2
Chicago, IL 60647-5406
Phone (919) 451-3208

Other practice location 1

2160 S 1st Ave
Maywood, IL 60153-3328
Phone (708) 216-5118

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ksmith42295@direct.luhs.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240411003074 AZ Practitioner - Hospitalist 5294903746 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
71767AZMDPediatrics Physician
036.127672ILMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
TMC Medical Network CurrentSince Apr 30, 2024 Accepting new patients
Loyola University Medical Center Current Accepting new patients

Locations

5301 E Grant Rd
Tucson, AZ 85712
Phone (520) 324-1344

2380 N Ferguson Ave
Ste 104
Tucson, AZ 85712
Phone (520) 324-1010

2160 S 1st Ave
Maywood, IL 60153
Phone (708) 216-4400

Organizations & group practices 2

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": "1182902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712016000000",
    "number": "1063619849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2157 W CONCORD PL",
            "address_2": "APT 2",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606475406",
            "telephone_number": "919-451-3208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5301 E GRANT RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857122805",
            "telephone_number": "520-324-5461"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2160 S 1st Ave",
            "address_purpose": "LOCATION",
            "city": "Maywood",
            "state": "IL",
            "postal_code": "601533328",
            "country_code": "US",
            "telephone_number": "708-216-5118",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-27",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "71767",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "71767",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IL",
            "license": "036.127672",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "AZ",
            "license": "71767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ksmith42295@direct.luhs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2160 S 1st Ave",
            "city": "Maywood",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601533328",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.