Sid C Smith, DDS

Primary specialty

DentistTaxonomy code 122300000X

Practice address

119 E Clinton Ave
Monmouth, IL 61462-5710

Phone

(309) 734-3611

Fax

(309) 734-8080

NPI assigned

Nov 4, 2005

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1131062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083605257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 E CLINTON AVE",
            "address_2": "PO BOX 645",
            "city": "MONMOUTH",
            "state": "IL",
            "postal_code": "614625710",
            "telephone_number": "309-734-3611",
            "fax_number": "309-734-8080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 E CLINTON AVE",
            "city": "MONMOUTH",
            "state": "IL",
            "postal_code": "614625710",
            "telephone_number": "309-734-3611",
            "fax_number": "309-734-8080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "SID",
        "middle_name": "C",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Shearer, R. PH
• Leah Shimmin, APNCNP
• Shopko Stores Operating Co LLC (ShopKo Pharmacy 145)
• Shopko Stores Operating Co. LLC (ShopKo Optical 145)
• Michelle N Smith, RN
• Patrick Spears
• Angela Kay Taylor, APRN
• Christy Lynn Thornton, APN
• Amy S Toal, LMT
• John Turnquist

• Dentist in Monmouth, IL
• Providers in Monmouth, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.