Active NPI
Jeffrey D Smith, MD
- Plastic Surgery Physician
- Petoskey, MI
National Provider Identifier
1144203175
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- License
- 4301059444
- Practice address
- 4170 Cedar Bluff Dr
Petoskey, MI 49770-7627 - Phone
- (231) 487-2230
- Fax
- (231) 487-6172
- NPI assigned
- Nov 23, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | 4301059444 | MI | Primary |
| Specialist | 174400000X | 204149 | MA |
Addresses
Primary practice location
4170 Cedar Bluff Dr
Petoskey, MI 49770-7627
Mailing address
11149 Summerhill Way
Charlevoix, MI 49720-9077
Phone (978) 505-7006
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144203175 | Medicaid | MI | |
| 3208079 | Medicaid | MA |
Other names 1
- Dr. Jeffrey D Smith
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 204149 | MA | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northeast Plastic Surgery | 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.
-
- Ambulatory Surgical Clinic/Center
- Chelmsford, MA
- NPI 1356585145
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1619568000000",
"number": "1144203175",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11149 SUMMERHILL WAY",
"city": "CHARLEVOIX",
"state": "MI",
"postal_code": "497209077",
"telephone_number": "978-505-7006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4170 CEDAR BLUFF DR",
"city": "PETOSKEY",
"state": "MI",
"postal_code": "497707627",
"telephone_number": "231-487-2230",
"fax_number": "231-487-6172"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "JEFFREY",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-23",
"last_updated": "2021-04-28",
"certification_date": "2021-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "MI",
"license": "4301059444",
"primary": true
},
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "MA",
"license": "204149",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1144203175",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3208079",
"state": "MA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JEFFREY",
"last_name": "SMITH",
"middle_name": "D",
"prefix": "DR.",
"credential": "MD",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Petoskey, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.