Individual provider Active NPI

Roland Theodore Smith, M.D.

  • Ophthalmology Physician
  • New York, NY
National Provider Identifier
1174543029
Registry record updated May 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
151173-1 Issued in NY
Practice address
635 W 165TH St
Box 92
New York, NY 10032-3724
Phone
(212) 283-5222
NPI assigned
Jul 20, 2006
Last updated
May 9, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 9, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 151173-1 NY Primary

Addresses

Primary practice location

635 W 165TH St
Box 92
New York, NY 10032-3724

Mailing address

635 W 165TH St
Box 92
New York, NY 10032-3724
Phone (212) 283-5222

Other identifiers 1

IdentifierTypeStateIssuer
01113964MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031103000520 NY Practitioner - Ophthalmology 6709798259 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Albert Einstein College of Medicine of Yeshiva University, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

310 E 14TH St
Opthalmology Department of Mount Sinai
New York, NY 10003-4201
Phone (212) 241-0939

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
151173-1NYMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai Ophthalmology CurrentSince May 1, 2022 Accepting new patients
Icahn School of Medicine at Mount Sinai Ophthalmology CurrentSince May 1, 2022 Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients
Trustees of Columbia University in the City of New York Ophthalmology Past Accepting new patients

Locations

218 2nd Ave
New York, NY 10003
Phone (212) 979-4000

310 E 14th St
New York, NY 10003
Phone (212) 979-4000

310 E 14th St
Ste 319
New York, NY 10003
Phone (212) 979-4500

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: rsmith@efp1740.srs-direct.com
  • Direct secure messaging: rsmith682927@nychhc.direct-ci.com

Organizations & group practices 4

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368057600000",
    "number": "1174543029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 W 165TH ST",
            "address_2": "BOX 92",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323724",
            "telephone_number": "212-283-5222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 W 165TH ST",
            "address_2": "BOX 92",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323724",
            "telephone_number": "212-283-5222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "ROLAND",
        "middle_name": "THEODORE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2013-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NY",
            "license": "151173-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01113964",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.