Jill Suzanne Smith, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

01066193A Issued in IN

Practice address

100 S Rosenberger Ave Ste B400
Evansville, IN 47712-6510

Phone

(812) 485-1566

NPI assigned

Feb 6, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jill.smith.1@7598.direct.athenahealth.com

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.

• St Mary'S Medical Group, LLC

  • Family Medicine Physician
  • Evansville, IN
  • NPI 1164852539

  Pediatrics

  Medicare reassignment NPD
• St Mary'S Medical Group, LLC

  • Nephrology Physician
  • Evansville, IN
  • NPI 1619307873
  NPD
• St. Mary'S Health, Inc

  • Internal Medicine Physician
  • Evansville, IN
  • NPI 1497706287

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660089600000",
    "number": "1194864017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 S ROSENBERGER AVE STE B400",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477126510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S ROSENBERGER AVE STE B400",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477126510",
            "telephone_number": "812-485-1566"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3900 Washington Ave Ste 200",
            "address_purpose": "LOCATION",
            "city": "Evansville",
            "state": "IN",
            "postal_code": "477140550",
            "country_code": "US",
            "telephone_number": "812-485-7780",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JILL",
        "middle_name": "SUZANNE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-06",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01066193A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200945890",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jill.smith.1@7598.direct.athenahealth.com",
            "affiliation": "Y",
            "affiliationName": "St Mary's Medical Group, LLC",
            "address_1": "100 S Rosenberger Ave Ste B400",
            "city": "Evansville",
            "state": "IN",
            "country_code": "US",
            "postal_code": "477126510",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jae Smith, BSW, MATS
• Jenna K Smith, PHARMD
• Jenna Nicole Smith, WHNP
• Jennifer Lynn Smith
• Jessie Marie Smith
• Kayce Smith, LCSW
• Kaytlin Nicole Galloway Smith, PT, DPT
• Matthew Smith, DDS
• Samantha Rae Smith, B.S.
• Shannon E Smith, CSFA

• Pediatrics Physician in Evansville, IN
• Providers in Evansville, IN by specialty
• Pediatrics Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.