Martin D Smith, RD, LD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

280 Issued in AK

Practice address

2960 Tongass Ave
Ketchikan, AK 99901-5742

Phone

(907) 228-9441

Fax

(800) 591-0121

NPI assigned

Mar 26, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Ketchikan Indian Corporation

  dba KIC Tribal Health Clinic

  • Primary Care Clinic/Center
  • Ketchikan, AK
  • NPI 1821120486

  TX

  Medicare reassignment

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

{
    "created_epoch": "1332720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332720000000",
    "number": "1194091041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2960 TONGASS AVE",
            "city": "KETCHIKAN",
            "state": "AK",
            "postal_code": "999015742",
            "telephone_number": "907-228-9441",
            "fax_number": "800-591-0121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2960 TONGASS AVE",
            "city": "KETCHIKAN",
            "state": "AK",
            "postal_code": "999015742",
            "telephone_number": "907-228-9441",
            "fax_number": "800-591-0121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MARTIN",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "credential": "RD, LD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-03-26",
        "last_updated": "2012-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "AK",
            "license": "280",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alicia Jo Smith
• Eugenia Smith
• Jalen Smith
• Jennifer Leigh Smith
• Kimberly Smith
• Zachary York Smith
• Angie Smitley
• Jamie Snipes
• Leslie Snodderly
• Wynelle R Snow, MD

• Registered Dietitian in Ketchikan, AK
• Providers in Ketchikan, AK by specialty
• Registered Dietitian in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2012; 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.