Raphael G Smith, PSY D, HSPP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2009038103 Issued in MO

Practice address

4044 Central St
Kansas City, MO 64111-2228

Phone

(816) 960-4525

NPI assigned

Dec 28, 2005

Last updated

Feb 11, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1135728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265846400000",
    "number": "1093792392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4044 CENTRAL ST",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641112228",
            "telephone_number": "816-960-4525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4044 CENTRAL ST",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641112228",
            "telephone_number": "816-960-4525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "RAPHAEL",
        "middle_name": "G",
        "credential": "PSY D, HSPP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-28",
        "last_updated": "2010-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20041042A",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "2009038103",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200095120",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS",
            "identifier": "000000188733",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHN",
            "identifier": "343420",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael W Smith
• Misty M Smith, FNP-C
• Monica Marie Smith, LPN
• Nicholas James Smith, FNP
• Phillip Smith, LPC, RASAC II
• Reid Conlee Smith, MD
• Rhonda Laurine Smith, DC
• Rikki Nicole Smith, RN
• Ryan Philip Smith, PA-C
• Sada Smith

• Clinical Psychologist in Kansas City, MO
• Providers in Kansas City, MO by specialty
• Clinical Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.