Individual provider Active NPI

Joe Dolan Smith III

  • Student in an Organized Health Care Education/Training Program
  • Saint Louis, MO
National Provider Identifier
1124794318
Registry record updated May 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
4590 Nash Way
Saint Louis, MO 63110-1020
Phone
(314) 747-3000
NPI assigned
Aug 18, 2021
Last updated
May 9, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X OK Primary

Addresses

Primary practice location

4590 Nash Way
Saint Louis, MO 63110-1020

Mailing address

4590 Nash Way
Saint Louis, MO 63110-1020
Phone (314) 273-8650

Other practice location 1

800 Stanton L Young Blvd
Oklahoma City, OK 73104-5018
Phone (405) 271-2316

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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 1

Enrollment IDStateProvider typePAC IDDetails
I20250703001774 MO Order and Referring Only - AnesthesiologyPractitioner - Anesthesiology 3072026855

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1629244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746748800000",
    "number": "1124794318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4590 NASH WAY",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101020",
            "telephone_number": "314-273-8650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4590 NASH WAY",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101020",
            "telephone_number": "314-747-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Stanton L Young Blvd",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731045018",
            "country_code": "US",
            "telephone_number": "405-271-2316",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JOE",
        "middle_name": "DOLAN",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-18",
        "last_updated": "2025-05-09",
        "certification_date": "2025-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.