Individual provider Active NPI

Lisa A Smith, M.D.

  • Pediatric Surgery Physician
  • Chattanooga, TN
National Provider Identifier
1225022890
Registry record updated Feb 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Surgery PhysicianTaxonomy code 2086S0120X
License
MD34792 Issued in TN
Practice address
979 E 3Rd St
Ste 300
Chattanooga, TN 37403-2136
Phone
(423) 267-0466
Fax
(423) 757-0775
NPI assigned
Sep 9, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Surgery Physician 2086S0120X MD34792 TN Primary
Surgery Physician 208600000X MD34792 TN

Addresses

Primary practice location

979 E 3Rd St
Ste 300
Chattanooga, TN 37403-2136

Mailing address

979 E 3Rd St
Ste 300
Chattanooga, TN 37403-2136
Phone (423) 267-0466

Other identifiers 10

IdentifierTypeStateIssuer
370017967OtherRR MEDICARE
2536518MedicaidOH
00893516AMedicaidGA
7613562MedicaidNC
4001261OtherBCBS OF TN
Q000856MedicaidTN
1246480 002OtherCIGNA
1700058OtherUHC
009947640MedicaidAL
62165877467OtherJDH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20070606000214 TN Practitioner - Pediatric MedicinePractitioner - General Surgery 5092813634 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD34792TNMDSurgery Physician
34792TNMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University Surgical Associates, PLLC Surgery CurrentSince May 11, 2009 Accepting new patients
University Surgical Associates PC Surgery Past Accepting new patients
Erlanger Health Past Accepting new patients

Locations

1635 Gunbarrel Rd
Ste 210
Chattanooga, TN 37421

979 E 3rd St
Ste 300
Chattanooga, TN 37403
Phone (423) 757-0792

2253 Chambliss Ave NW
Ste 401
Cleveland, TN 37311

Interoperability endpoints

  • Direct secure messaging: lisa.smith.1@33371.direct.athenahealth.com
  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.71772

Organizations & group practices 3

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": "1126224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550448000000",
    "number": "1225022890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "979 E 3RD ST",
            "address_2": "STE 300",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374032136",
            "telephone_number": "423-267-0466",
            "fax_number": "423-757-0775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "979 E 3RD ST",
            "address_2": "STE 300",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374032136",
            "telephone_number": "423-267-0466",
            "fax_number": "423-757-0775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "LISA",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-09",
        "last_updated": "2019-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "TN",
            "license": "MD34792",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TN",
            "license": "MD34792",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "370017967",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2536518",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00893516A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7613562",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TN",
            "identifier": "4001261",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q000856",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1246480 002",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "1700058",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009947640",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JDH",
            "identifier": "62165877467",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chattanooga, TN

Sources for this page

Verify at the official NPI Registry.