Active NPI
Jamie Lynn Smith, D.D.S., M.S.
- Pediatric Dentistry
- Peoria Heights, IL
National Provider Identifier
1093926768
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 021002311
- Practice address
- 4207 N Prospect Rd
Peoria Heights, IL 61616-7754 - Phone
- (309) 685-4444
- NPI assigned
- May 24, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 021002311 | IL | Primary |
| Dentist | 122300000X | 01927346 | IL |
Addresses
Primary practice location
4207 N Prospect Rd
Peoria Heights, IL 61616-7754
Mailing address
11013 N Onyx LN
Dunlap, IL 61525-9579
Phone (309) 243-8359
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150707000609 | IL | Order and Referring Only - Oral Surgery | 2769794635 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01927346 | IL | MD | Dentist |
| 021002311 | IL | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377129600000",
"number": "1093926768",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11013 N ONYX LN",
"city": "DUNLAP",
"state": "IL",
"postal_code": "615259579",
"telephone_number": "309-243-8359"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4207 N PROSPECT RD",
"city": "PEORIA HEIGHTS",
"state": "IL",
"postal_code": "616167754",
"telephone_number": "309-685-4444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "JAMIE",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "D.D.S., M.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-24",
"last_updated": "2013-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "IL",
"license": "021002311",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "01927346",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria Heights, IL
- Rose Garden Care Center Inc.
- Hannah S. Schultz, OTD, OTR/L
- Lisa M Schwab, LCPC
- Sharshon Pharmacy. Inc. (Smith Easy Care Pharmacy)
- Jennifer A Siefert, RPH
- Kevin Spangler, APN
- Megan Stickelmaier, LCSW
- Molly K. Suellentrop, COTA/L
- Village of Peoria Heights (Peoria Heights Ambulance Service)
- Caitlyn Clare Wagenbach, PA-C
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2013; 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.