Individual provider Active NPI

Stephen James Smenkowski, PA-C

  • Physician Assistant
  • Lecanto, FL
National Provider Identifier
1104804905
Registry record updated Apr 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
62800 Issued in CA
Practice address
2793 N Brentwood Cir
Lecanto, FL 34461-7779
Phone
(302) 299-8268
NPI assigned
Jan 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2025

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 62800 CA Primary

Addresses

Primary practice location

2793 N Brentwood Cir
Lecanto, FL 34461-7779

Mailing address

2793 N Brentwood Cir
Lecanto, FL 34461-7779
Phone (302) 299-8268

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, CA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20230206003199 FL Practitioner - Physician Assistant 9739372319 Reassigns benefits to 1 organization
I20240206004552 CA Practitioner - Physician Assistant 9739372319 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Drexel University College of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Native American Mental Health Services CorporationGroup PAC ID 5395072490, 62 clinicians

Practice addresses (Care Compare)

1742 Oregon St
Redding, CA 96001-1717
Phone (530) 646-7269

420 S Main St
Red Bluff, CA 96080-4316
Phone (888) 297-8080

800 W Harris St
Suite 33
Eureka, CA 95503-3929
Phone (707) 296-7660

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
62800CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Christiana Care Quality Partners PastSince Aug 1, 2021 Accepting new patients

Organizations & group practices 3

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": "1136246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743465600000",
    "number": "1104804905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2793 N BRENTWOOD CIR",
            "city": "LECANTO",
            "state": "FL",
            "postal_code": "344617779",
            "telephone_number": "302-299-8268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2793 N BRENTWOOD CIR",
            "city": "LECANTO",
            "state": "FL",
            "postal_code": "344617779",
            "telephone_number": "302-299-8268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMENKOWSKI",
        "first_name": "STEPHEN",
        "middle_name": "JAMES",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-03",
        "last_updated": "2025-04-01",
        "certification_date": "2025-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "62800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lecanto, FL

Sources for this page

Verify at the official NPI Registry.