Individual provider Active NPI

C River Smith, PH.D.

  • Psychologist
  • Cleveland, OH
National Provider Identifier
1205965480
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
4658 Issued in OH
Practice address
11206 Clifton Blvd
Cleveland, OH 44102-1407
Phone
(216) 651-1302
NPI assigned
Mar 5, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 4658 OH Primary

Addresses

Primary practice location

11206 Clifton Blvd
Cleveland, OH 44102-1407

Mailing address

11206 Clifton Blvd
Cleveland, OH 44102-1407
Phone (216) 651-1302

Other identifiers 1

IdentifierTypeStateIssuer
0923479MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040903000283 OH Practitioner - Clinical Psychologist 4082680764 Practice locations: Cleveland, OH; Lakewood, OH

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

15644 Madison Ave
Suite 206
Lakewood, OH 44107-5622
Phone (216) 651-1302

4471 W 226TH St
Fairview Park, OH 44126-2569

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4658OHMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Psychology Consultants Inc PastSince Nov 7, 1997 Accepting new patients

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/psychologyconsultantsinc/r4/

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1205965480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11206 CLIFTON BLVD",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441021407",
            "telephone_number": "216-651-1302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11206 CLIFTON BLVD",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441021407",
            "telephone_number": "216-651-1302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "C",
        "middle_name": "RIVER",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-05",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OH",
            "license": "4658",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0923479",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.