Active NPI
Robert W Smith, M.D.
- Diagnostic Radiology Physician
- Saint Louis, MO
National Provider Identifier
1144205576
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 33449
- Practice address
- 10010 Kennerly Rd
Saint Louis, MO 63128-2106 - Phone
- (314) 525-4492
- Fax
- (314) 525-4481
- NPI assigned
- Dec 8, 2005
- 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 |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 33449 | MO | Primary |
Addresses
Primary practice location
10010 Kennerly Rd
Saint Louis, MO 63128-2106
Mailing address
11475 Olde Cabin Rd Ste 200
Saint Louis, MO 63141-7129
Phone (314) 991-8200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200258200 | Medicaid | MO |
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 |
|---|---|---|---|
| 33449 | MO | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134000000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1524441600000",
"number": "1144205576",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11475 OLDE CABIN RD STE 200",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631417129",
"telephone_number": "314-991-8200",
"fax_number": "314-991-8206"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10010 KENNERLY RD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631282106",
"telephone_number": "314-525-4492",
"fax_number": "314-525-4481"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "ROBERT",
"middle_name": "W",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-08",
"last_updated": "2018-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "MO",
"license": "33449",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200258200",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.