Samuel Dennison Smith, PAC, ATC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1205273

Practice address

2200 Bryant Williams Dr
Klamath Falls, OR 97601-1120

Phone

(541) 884-7746

NPI assigned

Sep 4, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

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 1

Specialty

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sky Lakes Medical Center IncGroup PAC ID 1052204096, 196 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sky Lakes Medical Center Hospital, Klamath Falls, OR, CCN 380050
• Lake District Hospital Hospital, Lakeview, OR, CCN 381309
• Modoc Medical Center Hospital, Alturas, CA, CCN 051330

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Sky Lakes Medical Center Inc

  • General Acute Care Hospital
  • Klamath Falls, OR
  • NPI 1659340370

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Lake Health District

  dba Lake District Hospital and LongTerm Care

  • Critical Access Hospital
  • Lakeview, OR
  • NPI 1851399695
  NPD (past)
• Sky Lakes Medical Center Inc

  • General Practice Physician
  • Klamath Falls, OR
  • NPI 1649446691

  Single Specialty

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Lake Health District

  dba Lake District Hospital

  • Critical Access Hospital
  • Lakeview, OR
  • NPI 1376698522
  Care Compare affiliation
• Sky Lakes Medical Center Inc

  • Occupational Therapist
  • Klamath Falls, OR
  • NPI 1134270911

  Hospital

  Care Compare affiliation
• Sky Lakes Medical Center Inc

  • General Acute Care Hospital
  • Klamath Falls, OR
  • NPI 1659340370
  Care Compare affiliation
• Last Frontier Healthcare District

  dba Modoc Medical Center

  • Critical Access Hospital
  • Alturas, CA
  • NPI 1487669032
  Care Compare affiliation
• Last Frontier Healthcare District

  dba Modoc Medical Center

  • Rural Health Clinic/Center
  • Alturas, CA
  • NPI 1487764064

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1567555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696809600000",
    "number": "1144878059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "877 QUARRY RD",
            "city": "MIDDLEBURY",
            "state": "VT",
            "postal_code": "057538441",
            "telephone_number": "802-349-2194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 BRYANT WILLIAMS DR",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976011120",
            "telephone_number": "541-884-7746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "SAMUEL",
        "middle_name": "DENNISON",
        "credential": "PAC, ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-09-04",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": "1205273",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaylen Jade Smith
• Michelle D Smith, RPH
• Nicholas A Smith, DMD
• Paula S Smith, RD, LD, CDE
• Rance Alan Smith
• Stanton T Smith, MD
• Tracy Alexander Smith, DMD
• Dyer Snider, QMHP
• Timothy Lon Snipes
• Erin Snodgrass, CNM

• Physician Assistant in Klamath Falls, OR
• Providers in Klamath Falls, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.