Active NPI
Kenneth W Smith, P.T.
- Physical Therapist
- Prineville, OR
National Provider Identifier
1184773954
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 0963
- Practice address
- 1251 NE Elm St
Ste 2-a
Prineville, OR 97754-1206 - Phone
- (541) 447-6846
- Fax
- (541) 447-1243
- NPI assigned
- Jan 9, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 0963 | OR | Primary |
Addresses
Primary practice location
1251 NE Elm St
Ste 2-a
Prineville, OR 97754-1206
Mailing address
1251 NE Elm St
Ste 2-a
Prineville, OR 97754-1206
Phone (541) 447-6846
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 160010 | Medicaid | OR |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0963 | OR | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Omnis Omnia Inc. | Past | Accepting new patients | |
| Kenneth W Smith PT | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba Peak Performance Physical Therapy
- Orthopedic Physical Therapist
- Redmond, OR
- NPI 1013949239
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1191888000000",
"number": "1184773954",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1251 NE ELM ST",
"address_2": "STE 2-A",
"city": "PRINEVILLE",
"state": "OR",
"postal_code": "977541206",
"telephone_number": "541-447-6846",
"fax_number": "541-447-1243"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1251 NE ELM ST",
"address_2": "STE 2-A",
"city": "PRINEVILLE",
"state": "OR",
"postal_code": "977541206",
"telephone_number": "541-447-6846",
"fax_number": "541-447-1243"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "KENNETH",
"middle_name": "W",
"name_prefix": "Mr.",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-09",
"last_updated": "2007-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OR",
"license": "0963",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "160010",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Prineville, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.