Individual provider Active NPI

Eric S. Smith, PH.D

  • Psychologist
  • Detroit, MI
National Provider Identifier
1154467504
Registry record updated Sep 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Practice address
19445 W Warren Ave
Detroit, MI 48228-3361
Phone
(313) 307-0088
Fax
(313) 281-2235
NPI assigned
Jan 30, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 13, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Forensic Psychologist 103TF0200X 125 NV
Psychologist 103T00000X Primary

Addresses

Primary practice location

19445 W Warren Ave
Detroit, MI 48228-3361

Mailing address

19445 W Warren Ave
Detroit, MI 48228-3361
Phone (313) 307-0088

Other practice location 1

2600 Paseo Verde Pkwy
Suite 200
Henderson, NV 89074-7164
Phone (702) 434-5282

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.
Opted out of Medicare
Yes, effective Jul 1, 2017 through Jul 1, 2027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
125NVMDForensic Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Asnaa Psychologist PastSince Apr 5, 2020 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.

NPI Registry JSON

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631491200000",
    "number": "1154467504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19445 W WARREN AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482283361",
            "telephone_number": "313-307-0088",
            "fax_number": "313-281-2235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19445 W WARREN AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482283361",
            "telephone_number": "313-307-0088",
            "fax_number": "313-281-2235"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2600 Paseo Verde Pkwy",
            "address_2": "Suite 200",
            "address_purpose": "LOCATION",
            "city": "Henderson",
            "state": "NV",
            "postal_code": "890747164",
            "country_code": "US",
            "telephone_number": "702-434-5282",
            "fax_number": "702-434-4679",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "ERIC",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "PH.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-30",
        "last_updated": "2021-09-13",
        "certification_date": "2021-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "NV",
            "license": "125",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.