NPIMap

Individual provider Active NPI

Paul A Smith, ANP

  • Family Nurse Practitioner
  • New Boston, TX
National Provider Identifier
1083616080
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
506033 Issued in TX
Practice address
128 N Ellis St
New Boston, TX 75570-2904
Phone
(903) 628-1104
Fax
(903) 628-0104
NPI assigned
Aug 10, 2005
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 506033 TX Primary
Family Nurse Practitioner 363LF0000X A01143 AR

Addresses

Primary practice location

128 N Ellis St
New Boston, TX 75570-2904

Mailing address

5002 Cowhorn Creek Rd
Texarkana, TX 75503-9766
Phone (903) 614-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061026000199 TX Practitioner - Nurse Practitioner 4183621626 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

128 N Ellis St
New Boston
New Boston, TX 75570-2904
Phone (903) 628-1104

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
A01143ARMDFamily Nurse Practitioner
506033TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Collom & Carney Clinic Association Current Accepting new patients
Collom & Carney Clinic Association Current Accepting new patients
Collom & Carney Clinic Association Current Accepting new patients
Collom & Carney Clinic Association CurrentSince Dec 1, 1999 Accepting new patients
Collom & Carney Clinic Association CurrentSince Dec 1, 1999 Accepting new patients
Collom & Carney Clinic Association Current Accepting new patients
Collom and Carney Clinic Association Past Accepting new patients
Collom and Carney Clinic Association Past Accepting new patients

Locations

128 N Ellis St
New Boston, TX 75570
Phone (903) 628-1104

2931 Richmond Rd
Texarkana, TX 75503
Phone (903) 614-3200

5002 Cowhorn Creek Rd
Texarkana, TX 75503
Phone (903) 614-3008

815 N Kings Hwy
Wake Village, TX 75501
Phone (903) 614-3700

Interoperability endpoints

  • Direct secure messaging: paul.smith.p1@direct.collom-carney.nextgenshare.com

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083616080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5002 COWHORN CREEK RD",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755039766",
            "telephone_number": "903-614-3000",
            "fax_number": "903-614-3525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 N ELLIS ST",
            "city": "NEW BOSTON",
            "state": "TX",
            "postal_code": "755702904",
            "telephone_number": "903-628-1104",
            "fax_number": "903-628-0104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "PAUL",
        "middle_name": "A",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "506033",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "A01143",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Boston, TX

Sources for this page

Verify at the official NPI Registry.