NPIMap

Individual provider Active NPI

Barry A. Smith, D.O.

  • Surgery Physician
  • Lewiston, ID
National Provider Identifier
1083731103
Registry record updated Dec 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
O-0654 Issued in ID
Practice address
307 Saint Johns Way Ste 4
Lewiston, ID 83501-2435
Phone
(208) 743-7612
NPI assigned
Mar 23, 2007
Last updated
Dec 11, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X OS013507 PA
Surgery Physician 208600000X O-0654 ID Primary

Addresses

Primary practice location

307 Saint Johns Way Ste 4
Lewiston, ID 83501-2435

Mailing address

307 Saint Johns Way Ste 4
Lewiston, ID 83501-2435
Phone (208) 743-7612

Other practice location 1

401 E Hawaii
Nampa, ID 53686-6014
Phone (208) 465-6940

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, WA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120727000444 ID Practitioner - General Surgery 8820254303 Reassigns benefits to 3 organizations
I20240520001728 WA Practitioner - General Surgery 8820254303 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Arizona College of Osteopathic Medicine Mid Western University, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tri-State Memorial HospitalGroup PAC ID 4082502422, 33 clinicians
Syringa General Hospital District C I FGroup PAC ID 6800707530, shared by 4 NPIs, 19 clinicians

Practice addresses (Care Compare)

1119 Highland Ave
Clarkston, WA 99403-2836
Phone (509) 758-5511

607 W Main St
Grangeville, ID 83530-1345
Phone (208) 983-1700

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS013507PAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Syringa General Hospital District C I F CurrentSince Nov 1, 2021 Accepting new patients
Tri-State Memorial Hospital Surgery Current Accepting new patients
Syringa General Hospital District C I F CurrentSince Nov 1, 2021 Accepting new patients
Tri-State Memorial Hospital CurrentSince May 1, 2024 Accepting new patients
Tri-State Memorial Hospital CurrentSince May 1, 2024 Accepting new patients
Saint Alphonsus Specialty Services Inc Surgery Past Accepting new patients
Saint Alphonsus Regional Medical Center Inc Past Accepting new patients

Locations

607 W Main St
Grangeville, ID 83530
Phone (208) 983-1700

1119 Highland Ave
Clarkston, WA 99403
Phone (509) 758-1450

1119 Highland Ave
Ste 4
Clarkston, WA 99403
Phone (509) 254-0080

1221 Highland Ave
Clarkston, WA 99403
Phone (509) 751-0312

Organizations & group practices 9

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 5

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": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576022400000",
    "number": "1083731103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 SAINT JOHNS WAY STE 4",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835012435",
            "telephone_number": "208-743-7612",
            "fax_number": "208-746-4802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 SAINT JOHNS WAY STE 4",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835012435",
            "telephone_number": "208-743-7612"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "401 E Hawaii",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "536866014",
            "country_code": "US",
            "telephone_number": "208-465-6940",
            "fax_number": "208-465-6961",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "BARRY",
        "middle_name": "A.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-23",
        "last_updated": "2019-12-11",
        "certification_date": "2019-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "OS013507",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "ID",
            "license": "O-0654",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewiston, ID

Sources for this page

Verify at the official NPI Registry.