Individual provider Active NPI

Joshua Smith, PA-C

  • Physician Assistant
  • Henderson, NV
National Provider Identifier
1104122746
Registry record updated Jan 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA1384 Issued in NV
Practice address
291 N Pecos Rd
Henderson, NV 89074-1918
Phone
(702) 616-9471
Fax
(702) 616-9681
NPI assigned
Jan 30, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA1384 NV Primary

Addresses

Primary practice location

291 N Pecos Rd
Henderson, NV 89074-1918

Mailing address

291 N Pecos Rd
Henderson, NV 89074-1918
Phone (702) 616-9471

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130130000380 NV Practitioner - Physician Assistant 4183878093 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Shadow Emergency Physicians PLLC Physician Assistant CurrentSince Aug 15, 2017 Accepting new patients
Shadow Emergency Physicians PLLC CurrentSince Aug 15, 2017 Accepting new patients
Family Doctors Ramanathan, PLLC Past Accepting new patients
Katrina Di Pasqua DPM Inc Past Accepting new patients

Locations

620 Shadow Ln
Las Vegas, NV 89106
Phone (702) 388-4506

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EBDIBA/Endpoint/EBDIBA

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Family Doctors Ramanathan PLLC 7 clinicians

Practice addresses (Care Compare)

291 N Pecos Rd
Henderson, NV 89074-1918
Phone (702) 616-9471

Hospital & facility affiliations

  • Enhabit Home Health (Pecos) Home health agency, Henderson, NV, CCN 297102

NPI Registry JSON

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

{
    "created_epoch": "1296345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705536000000",
    "number": "1104122746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "291 N PECOS RD",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890741918",
            "telephone_number": "702-616-9471",
            "fax_number": "702-616-9681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "291 N PECOS RD",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890741918",
            "telephone_number": "702-616-9471",
            "fax_number": "702-616-9681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JOSHUA",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-01-30",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA1384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NV

Sources for this page

Verify at the official NPI Registry.