Active NPI
Susan Smart, PH.D.
- Psychologist
- Prairie Home, MO
National Provider Identifier
1093885592
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2000163196
- Practice address
- 22409 Ellis Davis Rd
Prairie Home, MO 65068-2143 - Phone
- (660) 841-5031
- NPI assigned
- Nov 9, 2006
- Last updated
- Aug 1, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2000163196 | MO | Primary |
Addresses
Primary practice location
22409 Ellis Davis Rd
Prairie Home, MO 65068-2143
Mailing address
22409 Ellis Davis Rd
Prairie Home, MO 65068-2143
Phone (660) 841-5031
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 499774826 | Medicaid | MO |
Other names 1
- Dr. Susan Smart
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jul 19, 2016 through Jul 19, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2000163196 | MO | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163030400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470009600000",
"number": "1093885592",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22409 ELLIS DAVIS RD",
"city": "PRAIRIE HOME",
"state": "MO",
"postal_code": "650682143",
"telephone_number": "660-841-5031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22409 ELLIS DAVIS RD",
"city": "PRAIRIE HOME",
"state": "MO",
"postal_code": "650682143",
"telephone_number": "660-841-5031"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMART",
"first_name": "SUSAN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-09",
"last_updated": "2016-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MO",
"license": "2000163196",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "499774826",
"state": "MO"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SUSAN",
"last_name": "SMART",
"prefix": "DR.",
"credential": "PH.D.",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Prairie Home, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2016; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.