Active NPI
Channel Smith
- Counselor
- Elkhart, IN
National Provider Identifier
1184252017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 1809 Visscher Dr
Elkhart, IN 46514-6505 - Phone
- (773) 491-5423
- NPI assigned
- Mar 27, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | IN | Primary |
Addresses
Primary practice location
1809 Visscher Dr
Elkhart, IN 46514-6505
Mailing address
1809 Visscher Dr
Elkhart, IN 46514-6505
Phone (773) 491-5423
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 83-4511368 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1585267200000",
"number": "1184252017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1809 VISSCHER DR",
"city": "ELKHART",
"state": "IN",
"postal_code": "465146505",
"telephone_number": "773-491-5423"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1809 VISSCHER DR",
"city": "ELKHART",
"state": "IN",
"postal_code": "465146505",
"telephone_number": "773-491-5423"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "CHANNEL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-03-27",
"last_updated": "2020-03-27",
"certification_date": "2020-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "IN",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "83-4511368",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elkhart, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.