Individual provider Active NPI

Kevin Deshaun Smith, M.D.

  • Hospitalist Physician
  • Austell, GA
National Provider Identifier
1205222189
Registry record updated Oct 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
83486 Issued in GA
Practice address
3950 Austell Rd
Austell, GA 30106
Phone
(770) 732-4022
NPI assigned
Apr 8, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 15, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Internal Medicine) Physician 207RH0002X 83486 GA
Student in an Organized Health Care Education/Training Program 390200000X
Hospitalist Physician 208M00000X 83486 GA Primary

Addresses

Primary practice location

3950 Austell Rd
Austell, GA 30106

Mailing address

3950 Austell Rd
Austell, GA 30106-1121
Phone (770) 732-4022

Other practice location 1

2301 Erwin Rd
Durham, NC 27710-4699
Phone (919) 684-8111

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ksmith343410@directwellstar.org

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20190809001992 GA Practitioner - Hospice/Palliative Care 2062761828 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hospice/Palliative Care
Education
Saint Louis University School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Practice addresses (Care Compare)

3000 Hospital Blvd
Roswell, GA 30076-4915
Phone (770) 751-2912

5150 Stilesboro N W Rd
Suite 220
Kennesaw, GA 30152-7742
Phone (770) 424-8222

625 Church Nest
Marietta, GA 30060-1101
Phone (770) 422-2004

677 Church Nest
Marietta, GA 30060-1101

677 Church St NE
Suite 100P
Marietta, GA 30060-1101
Phone (470) 793-8585

Hospital & facility affiliations

  • Wellstar Community Hospice Hospice, Austell, GA, CCN 111507
  • Wellstar North Fulton Medical Center Hospital, Roswell, GA, CCN 110198
  • Wellstar Kennestone Regional Medical Center Hospital, Marietta, GA, CCN 110035

Merit-based Incentive Payment System (MIPS)

Final score
93.93 of 100Reported as apm
Quality
82.14
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
83486GAMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC CurrentSince Jul 1, 2019 Accepting new patients
Wellstar Medical Group, LLC Current Accepting new patients

Locations

3950 Austell Rd
Austell, GA 30106
Phone (770) 732-3752

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

310 Kennestone Hospital Blvd
Marietta, GA 30060
Phone (770) 793-7899

Interoperability endpoints

  • Direct secure messaging: ksmith343410@directwellstar.org

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1428451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571097600000",
    "number": "1205222189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3950 AUSTELL RD",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301061121",
            "telephone_number": "770-732-4022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 AUSTELL RD",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "30106",
            "telephone_number": "770-732-4022"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2301 Erwin Rd",
            "address_purpose": "LOCATION",
            "city": "Durham",
            "state": "NC",
            "postal_code": "277104699",
            "country_code": "US",
            "telephone_number": "919-684-8111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KEVIN",
        "middle_name": "DESHAUN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-04-08",
        "last_updated": "2019-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": "GA",
            "license": "83486",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "GA",
            "license": "83486",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ksmith343410@directwellstar.org",
            "affiliation": "N",
            "address_1": "3950 Austell Rd",
            "city": "Austell",
            "state": "GA",
            "country_code": "US",
            "postal_code": "30106",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Austell, GA

Sources for this page

Verify at the official NPI Registry.