Individual provider Active NPI

Jason Arthur Smith, CRNA

  • Certified Registered Nurse Anesthetist
  • Dallas, TX
National Provider Identifier
1174884480
Registry record updated Mar 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704257113 Issued in MI
Practice address
13601 Preston Rd
Suite 1000W
Dallas, TX 75240-4911
Phone
(972) 715-5000
NPI assigned
Jun 4, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 4704257113 MI Primary

Addresses

Primary practice location

13601 Preston Rd
Suite 1000W
Dallas, TX 75240-4911

Mailing address

PO Box 660857
Dallas, TX 75266-0857
Phone (972) 715-5000

Other identifiers 3

IdentifierTypeStateIssuer
4308721320OtherMIBCBS
P01138205OtherMIRAILROAD MEDICARE
1174884480MedicaidMI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130125000426 MI Practitioner - Certified Registered Nurse Anesthetist (Crna) 8729232871 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
4704257113MIMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
GLPS Staffing Solutions LLC Nurse Anesthetist, Certified Registered CurrentSince Aug 1, 2015 Accepting new patients
Asa Staffing Inc Nurse Anesthetist, Certified Registered CurrentSince Dec 1, 2016 Accepting new patients
Northstar Anesthesia of Michigan II PC Nurse Anesthetist, Certified Registered CurrentSince Aug 22, 2023 Accepting new patients
Michigan Anesthesia Care One PC Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

1900 Columbus Ave
Bay City, MI 48708
Phone (989) 894-3000

3400 E Jolly Rd
Lansing, MI 48910
Phone (517) 272-1063

1707 Lake Lansing Rd
Lansing, MI 48912
Phone (517) 267-0033

1000 Harrington St
Mount Clemens, MI 48043
Phone (586) 493-3727

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1338768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363651200000",
    "number": "1174884480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 660857",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752660857",
            "telephone_number": "972-715-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13601 PRESTON RD",
            "address_2": "SUITE 1000W",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752404911",
            "telephone_number": "972-715-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JASON",
        "middle_name": "ARTHUR",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-04",
        "last_updated": "2013-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704257113",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4308721320",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01138205",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174884480",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.