NPIMap

Individual provider Active NPI

Tiffany Elaine Smith, PA

  • Physician Assistant
  • Louisville, KY
National Provider Identifier
1154576981
Registry record updated Aug 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA1075 Issued in KY
Practice address
2301 Terra Crossing Blvd
Suite 103
Louisville, KY 40245-4994
Phone
(502) 410-0191
Fax
(502) 890-5177
NPI assigned
Nov 20, 2008
Last updated
Aug 5, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA1075 KY Primary

Addresses

Primary practice location

2301 Terra Crossing Blvd
Suite 103
Louisville, KY 40245-4994

Mailing address

2301 Terra Crossing Blvd
Ste 103
Louisville, KY 40245-4994
Phone (502) 410-0191

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090121000551 KY Practitioner - Physician Assistant 0547324477 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
RadiantGroup PAC ID 8426337122, 4 clinicians

Practice addresses (Care Compare)

2301 Terra Crossing Blvd
Suite 103
Louisville, KY 40245-3909

2301 Terra Crossing Blvd
Suite 103
Louisville, KY 40245-4994
Phone (502) 410-0191

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Clarion Health and Wellness LLC Past Accepting new patients
First Stop Urgent Care Broadway PSC Physician Assistant PastSince Dec 30, 2012 Accepting new patients
Kentuckyone Health Medical Group, Inc. Physician Assistant Past Accepting new patients
First Stop Urgent Care Center PSC Physician Assistant Past Accepting new patients
First Stop Urgent Care Madison PSC Past Accepting new patients
First You Medical Center PLLC Physician Assistant Past Accepting new patients

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1227139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470355200000",
    "number": "1154576981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 TERRA CROSSING BLVD",
            "address_2": "STE 103",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402454994",
            "telephone_number": "502-410-0191",
            "fax_number": "502-890-5177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 TERRA CROSSING BLVD",
            "address_2": "SUITE 103",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402454994",
            "telephone_number": "502-410-0191",
            "fax_number": "502-890-5177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "TIFFANY",
        "middle_name": "ELAINE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-20",
        "last_updated": "2016-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA1075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.