Individual provider Active NPI

Jeremy Todd Smith, D.O.

  • Emergency Medicine Physician
  • Tulsa, OK
National Provider Identifier
1104047331
Registry record updated Jul 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
PENDING Issued in MS
Practice address
717 W 71St St
Tulsa, OK 74132-1824
Phone
(918) 517-6300
NPI assigned
May 2, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 12, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 4812 OK
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X PENDING MS Primary

Addresses

Primary practice location

717 W 71St St
Tulsa, OK 74132-1824

Mailing address

717 W 71St St
Tulsa, OK 74132-1824
Phone (918) 517-6300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK, MS2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130806000176 OK Practitioner - Emergency Medicine 0042384380 Reassigns benefits to 2 organizations
I20130806000327 MS Practitioner - Emergency Medicine 0042384380 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4812OKMDClinical Social Worker
PENDINGMSMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Services of Oklahoma PC Emergency Medicine CurrentSince Jun 1, 2014 Accepting new patients
St. John Physicians, Inc CurrentSince Jul 6, 2015 Accepting new patients
Keystone Medical Services of Ms, Inc Emergency Medicine CurrentSince Dec 6, 2013 Accepting new patients
Oklahoma Emergency Physician Partners PLLC Emergency Medicine Current Accepting new patients
Attala Emergency Group LLC Emergency Medicine CurrentSince Dec 16, 2013 Accepting new patients
St. John Physicians, Inc. Emergency Medicine CurrentSince Jul 6, 2015 Accepting new patients

Locations

1560 Sumrall Rd
Columbia, MS 39429
Phone (601) 736-6303

220 Highway 12 W
Kosciusko, MS 39090
Phone (662) 289-4311

1800 W University Blvd
Durant, OK 74701
Phone (580) 924-3080

4050 W Memorial Rd
Oklahoma City, OK 73120
Phone (405) 608-3200

1705 E 19th St
Ste 304
Tulsa, OK 74104
Phone (918) 748-7660

1923 S Utica Ave
Tulsa, OK 74104
Phone (918) 744-2345

1705 E 19th St
Ste 302
Tulsa, OK 74104
Phone (918) 748-7585

Organizations & group practices 6

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

NPI Registry JSON

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657584000000",
    "number": "1104047331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "717 W 71ST ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741321824",
            "telephone_number": "918-517-6300",
            "fax_number": "918-517-6309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 W 71ST ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741321824",
            "telephone_number": "918-517-6300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JEREMY",
        "middle_name": "TODD",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-02",
        "last_updated": "2022-07-12",
        "certification_date": "2022-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OK",
            "license": "4812",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MS",
            "license": "PENDING",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.