Active NPI
Kevin J Smith, PHD
- Clinical Psychologist
- Lyndhurst, OH
National Provider Identifier
1124113261
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 4780
- Practice address
- 5001 Mayfield Rd
Suite 200
Lyndhurst, OH 44124-2602 - Phone
- (216) 291-4000
- Fax
- (216) 291-4111
- NPI assigned
- Oct 4, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 4780 | OH | Primary |
Addresses
Primary practice location
5001 Mayfield Rd
Suite 200
Lyndhurst, OH 44124-2602
Mailing address
5001 Mayfield Rd
Suite 200
Lyndhurst, OH 44124-2602
Phone (216) 291-4000
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000190318 | Other | OH | ANTHEM |
| 0964256 | Medicaid | OH | |
| 6100371 | Other | OH | EVERCARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4780 | OH | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State of Ohio Office of Budget and Management State Accounting | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Nursing Facility/Intermediate Care Facility
- Sandusky, OH
- NPI 1790732576
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124113261",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5001 MAYFIELD RD",
"address_2": "SUITE 200",
"city": "LYNDHURST",
"state": "OH",
"postal_code": "441242602",
"telephone_number": "216-291-4000",
"fax_number": "216-291-4111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5001 MAYFIELD RD",
"address_2": "SUITE 200",
"city": "LYNDHURST",
"state": "OH",
"postal_code": "441242602",
"telephone_number": "216-291-4000",
"fax_number": "216-291-4111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "KEVIN",
"middle_name": "J",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OH",
"license": "4780",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000190318",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0964256",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EVERCARE",
"identifier": "6100371",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lyndhurst, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.