Individual provider Active NPI

Todd S Smith, PSYD

  • Clinical Neuropsychologist
  • Albany, GA
National Provider Identifier
1174683700
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
PSY002280 Issued in GA
Practice address
1211 Palmyra Rd
Albany, GA 31701-1935
Phone
(229) 439-8686
Fax
(229) 883-4484
NPI assigned
Dec 12, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X PSY002280 GA Primary

Addresses

Primary practice location

1211 Palmyra Rd
Albany, GA 31701-1935

Mailing address

1211 Palmyra Rd
Albany, GA 31701-1935
Phone (229) 439-8686

Other identifiers 1

IdentifierTypeStateIssuer
000861165AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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

Enrollment IDStateProvider typePAC IDDetails
I20080618000362 GA Practitioner - Clinical Psychologist 2163593294 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1211 Palmyra Rd
Albany, GA 31701-1935
Phone (229) 439-8686

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
South Georgia Neuropsychological Associates Clinical Neuropsychologist CurrentSince Sep 14, 2007 Accepting new patients

Locations

1211 Palmyra Rd
Albany, GA 31701
Phone (229) 432-9746

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": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174683700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 PALMYRA RD",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317011935",
            "telephone_number": "229-439-8686",
            "fax_number": "229-883-4484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 PALMYRA RD",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317011935",
            "telephone_number": "229-439-8686",
            "fax_number": "229-883-4484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "TODD",
        "middle_name": "S",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "GA",
            "license": "PSY002280",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000861165A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, GA

Sources for this page

Verify at the official NPI Registry.