Vincent Ross Smith, DNP, ANP-C

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

71008935A Issued in IN

Practice address

311 E 89TH Ave
Merrillville, IN 46410-8162

Phone

(219) 769-7062

Fax

(630) 495-1770

NPI assigned

Aug 30, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 7

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• Pinnacle Dermatology, SC

  • Dermatology Physician
  • Joliet, IL
  • NPI 1861930984

  IN

  Medicare reassignment NPD
• Dermatology and Plastic Surgery Associates, S.C.

  • Procedural Dermatology Physician
  • Joliet, IL
  • NPI 1700987328
  NPD (past)

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

{
    "created_epoch": "1346284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680739200000",
    "number": "1164771614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 SPRINGER DR",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601486413",
            "telephone_number": "708-634-4602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 E 89TH AVE",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464108162",
            "telephone_number": "219-769-7062",
            "fax_number": "630-495-1770"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1703 Calumet Ave",
            "address_purpose": "LOCATION",
            "city": "Valparaiso",
            "state": "IN",
            "postal_code": "463833128",
            "country_code": "US",
            "telephone_number": "219-242-8415",
            "fax_number": "815-744-3969",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "275 Joliet St Ste 225",
            "address_purpose": "LOCATION",
            "city": "Dyer",
            "state": "IN",
            "postal_code": "463111789",
            "country_code": "US",
            "telephone_number": "219-865-8800",
            "fax_number": "219-865-8908",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3800 Saint Mary Rd Ste 204",
            "address_purpose": "LOCATION",
            "city": "Valparaiso",
            "state": "IN",
            "postal_code": "463833986",
            "country_code": "US",
            "telephone_number": "219-769-7060",
            "fax_number": "630-495-1770",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9120 Columbia Ave",
            "address_purpose": "LOCATION",
            "city": "Munster",
            "state": "IN",
            "postal_code": "463212907",
            "country_code": "US",
            "telephone_number": "219-513-9415",
            "fax_number": "630-495-1770",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1601 Lafayette Rd",
            "address_purpose": "LOCATION",
            "city": "Crawfordsville",
            "state": "IN",
            "postal_code": "479331032",
            "country_code": "US",
            "telephone_number": "708-634-4602",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "275 Joliet St Ste 210",
            "address_purpose": "LOCATION",
            "city": "Dyer",
            "state": "IN",
            "postal_code": "463111789",
            "country_code": "US",
            "telephone_number": "219-865-8800",
            "fax_number": "219-865-8908",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "VINCENT",
        "middle_name": "ROSS",
        "name_prefix": "Mr.",
        "credential": "DNP, ANP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-30",
        "last_updated": "2023-04-06",
        "certification_date": "2023-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IN",
            "license": "28250476A",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "FL",
            "license": "RN9310400",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NV",
            "license": "RN80537",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CA",
            "license": "NP 22695",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NV",
            "license": "APRN001802",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "RN 805484",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IN",
            "license": "71008935A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MCO300042636",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Korencia Smith
• Larry Smith
• Mitchell G Smith, OD
• Patricia Smith
• Sharon Anise Smith, APRN
• Heather M Smott, DAT, ATC
• Haley Snmeis
• Alexandria Snowton
• Snyder Eyes PC
• Todd Alison Snyder, PSY.D.

• Adult Health Nurse Practitioner in Merrillville, IN
• Providers in Merrillville, IN by specialty
• Adult Health Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.