Individual provider Active NPI

Mandel Johnson Smith, RD

  • Registered Dietitian
  • Philadelphia, PA
National Provider Identifier
1083453260
Registry record updated Feb 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
DN006633 Issued in PA
Practice address
3401 N Broad St
Philadelphia, PA 19140-5103
Phone
(215) 707-4600
Fax
(215) 707-5599
NPI assigned
May 20, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X DN006633 PA Primary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X DN006633 PA

Addresses

Primary practice location

3401 N Broad St
Philadelphia, PA 19140-5103

Mailing address

3509 N Broad St
Philadelphia, PA 19140-4105
Phone (215) 707-2433

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251203002675 PA Practitioner - Registered Dietitian Or Nutrition Professional 6507359031 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 2017
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

3500 N Broad St
RM 1a
Philadelphia, PA 19140-4106

3500 N Broad St RM
1A
Philadelphia, PA 19140-4106

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN006633PAMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Temple Faculty Practice Plan Inc CurrentSince Sep 21, 2025 Accepting new patients
Temple Faculty Practice Plan Inc Current Accepting new patients
Temple Faculty Practice Plan, Inc CurrentSince Sep 21, 2025 Accepting new patients

Locations

3509 N Broad St
Philadelphia, PA 19140
Phone (215) 707-2433

3401 N Broad St
Philadelphia, PA 19140
Phone (215) 707-3807

2301 E Allegheny Ave
Philadelphia, PA 19134
Phone (215) 282-8000

Organizations & group practices 3

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": "1716163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769990400000",
    "number": "1083453260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3509 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191404105",
            "telephone_number": "215-707-2433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191405103",
            "telephone_number": "215-707-4600",
            "fax_number": "215-707-5599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MANDEL",
        "middle_name": "JOHNSON",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-20",
        "last_updated": "2026-02-02",
        "certification_date": "2026-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "PA",
            "license": "DN006633",
            "primary": true
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "PA",
            "license": "DN006633",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.