Active NPI
Jon Maurice Smoots
- Prevention Professional
- Milwaukee, WI
National Provider Identifier
1063981710
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prevention Professional
- License
- 1319081
- Practice address
- 7710 W. Casper Street
Milwaukee, WI 53216 - Phone
- (414) 231-1925
- NPI assigned
- Nov 23, 2018
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Prevention Professional | 405300000X | 1319081 | WI | Primary |
Addresses
Primary practice location
7710 W. Casper Street
Milwaukee, WI 53216
Mailing address
7710 W. Casper Street
Milwaukee, WI 53216
Phone (414) 231-1925
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1319081 | WI | MD | Prevention Professional |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1542931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1542931200000",
"number": "1063981710",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7710 W. CASPER STREET",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "53216",
"telephone_number": "414-231-1925"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7710 W. CASPER STREET",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "53216",
"telephone_number": "414-231-1925"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMOOTS",
"first_name": "JON",
"middle_name": "MAURICE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-11-23",
"last_updated": "2018-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "405300000X",
"taxonomy_group": "",
"desc": "Prevention Professional",
"state": "WI",
"license": "1319081",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.