NPIMap

Individual provider Active NPI

Jae Dell M Smith, NP-C

  • Family Nurse Practitioner
  • Tucson, AZ
National Provider Identifier
1215361787
Registry record updated Sep 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP5178 Issued in AZ
Practice address
1918 N Frances Blvd
Tucson, AZ 85712-3563
Phone
(520) 664-6523
NPI assigned
Sep 2, 2013
Last updated
Sep 19, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP5178 AZ Primary

Addresses

Primary practice location

1918 N Frances Blvd
Tucson, AZ 85712-3563

Mailing address

1918 N Frances Blvd
Tucson, AZ 85712-3563

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150609002469 TX Practitioner - Nurse Practitioner 8123349610 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ton San Xavier Health CenterGroup PAC ID 6608819339, 23 clinicians
Ton Sells HospitalGroup PAC ID 5092768663, 51 clinicians

Practice addresses (Care Compare)

7900 S J Stock Rd
Tucson, AZ 85746-7012
Phone (520) 547-8142

Highway 86 at Topawa Rd
Sells Indian Hospital
Sells, AZ 85634
Phone (520) 383-7285

Hwy 86 and Topawa Rd
Sells, AZ 85634

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP5178AZMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
DHHS IHS Phoenix Area CurrentSince Feb 6, 2017 Accepting new patients
DHHS IHS Phoenix Area CurrentSince Mar 25, 2016 Accepting new patients
DHHS IHS Phoenix Area CurrentSince Mar 25, 2016 Accepting new patients
Ton San Xavier Health Center CurrentSince Feb 3, 2019 Accepting new patients
Ton Sells Hospital CurrentSince Feb 18, 2019 Accepting new patients
Ton San Simon Health Center CurrentSince Feb 18, 2019 Accepting new patients
U S Health Dept of Health & Human Services CurrentSince Mar 21, 2015 Accepting new patients
Ton Santa Rosa Health Center CurrentSince Feb 18, 2019 Accepting new patients
US Health Dept of Health & Human Services CurrentSince Mar 21, 2015 Accepting new patients
Ton Santa Rosa Health Center Past Accepting new patients
Ton San Xavier Health Center Past Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients
Ton Sells Hospital Past Accepting new patients

Locations

7900 S J Stock Rd
Tucson, AZ 85746
Phone (520) 295-2550

7900 S J Stock Rd
Ste 645T
Tucson, AZ 85746

669 Agency Main St
Harlem, MT 59526
Phone (406) 353-3100

107 H St
Poplar, MT 59255
Phone (406) 738-3491

Organizations & group practices 13

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1378080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379548800000",
    "number": "1215361787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1918 N FRANCES BLVD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857123563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1918 N FRANCES BLVD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857123563",
            "telephone_number": "520-664-6523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JAE DELL",
        "middle_name": "M",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-02",
        "last_updated": "2013-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP5178",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.