Michael Wayne Smith- Fernandez, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

L10476 Issued in OR

Practice address

11 SW Brantley Dr
Winston, OR 97496-4526

Phone

(541) 679-0366

Fax

(541) 679-4821

NPI assigned

Jan 22, 2016

Last updated

Jan 25, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Second Wind Mental Health ClinicGroup PAC ID 2769792183, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Second Wind Mental Health Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Winston, OR
  • NPI 1679957708
  Medicare reassignment Care Compare group NPD
• Turningleaf Inc.

  • Mental Health Counselor
  • St George, UT
  • NPI 1316956667
  NPD (past)

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

{
    "created_epoch": "1453420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611532800000",
    "number": "1154788065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 SW BRANTLEY DR",
            "city": "WINSTON",
            "state": "OR",
            "postal_code": "974964526",
            "telephone_number": "541-679-0366",
            "fax_number": "541-679-4821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 SW BRANTLEY DR",
            "city": "WINSTON",
            "state": "OR",
            "postal_code": "974964526",
            "telephone_number": "541-679-0366",
            "fax_number": "541-679-4821"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3099 NE Diamond Lake Blvd",
            "address_purpose": "LOCATION",
            "city": "Roseburg",
            "state": "OR",
            "postal_code": "974703655",
            "country_code": "US",
            "telephone_number": "541-673-3469 x1510",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3099 NE Diamond Lake Blvd",
            "address_purpose": "LOCATION",
            "city": "Roseburg",
            "state": "OR",
            "postal_code": "974703655",
            "country_code": "US",
            "telephone_number": "541-673-3469 x1510",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1652 NW Hughwood Ct",
            "address_purpose": "LOCATION",
            "city": "Roseburg",
            "state": "OR",
            "postal_code": "974718844",
            "country_code": "US",
            "telephone_number": "541-673-3985 x401",
            "fax_number": "541-673-8060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH- FERNANDEZ",
        "first_name": "MICHAEL",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-01-22",
        "last_updated": "2021-01-25",
        "certification_date": "2021-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "L10476",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Oregon Community Dental Care
• Emily Ann Robertson, RDH
• Ronald F. Tribble, DMD, PC
• Jonathan Forrest Russell, PA
• Second Wind Mental Health Clinic
• Pazely Rachelle Spencer, PMHNP-BC
• Stacy J Nielsen, LCSW, LLC
• Coreen Stansfield
• Rabecca Marie Steele, LPN
• Sheila Marie Strauch, PHARMD

• Mental Health Counselor in Winston, OR
• Providers in Winston, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2021; 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.