Roosevelt J Smith

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

2930 Issued in NC

Practice address

4518-A West Market St
Greensboro, NC 27407

Phone

(336) 235-4022

Fax

(336) 235-4023

NPI assigned

Sep 15, 2006

Sex

Male

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

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Specialty

Chiropractic

Education

Life Chiropractic College, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Havenpath Supportive Living LLC

  • Community/Behavioral Health Agency
  • Greensboro, NC
  • NPI 1518839372
  NPD Authorized official
• HF Triad LLC

  • Chiropractor
  • Greensboro, NC
  • NPI 1871831370
  Authorized official Same address or phone
• Hstriad LLC

  • Chiropractor
  • Greensboro, NC
  • NPI 1750674735
  Authorized official Same address or phone
• RM Genesis Healthcare

  dba HealthSource

  • Health Maintenance Organization
  • Greensboro, NC
  • NPI 1861558512
  Authorized official Same address or phone

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1235235680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4518-A WEST MARKET ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "27407",
            "telephone_number": "336-235-4022",
            "fax_number": "336-235-4023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4518-A WEST MARKET ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "27407",
            "telephone_number": "336-235-4022",
            "fax_number": "336-235-4023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "ROOSEVELT",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "NC",
            "license": "2930",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89085AM",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Morgan C Smith, PTA
• Myla Smith
• Nathan Luke Smith, DC
• Ritchie Huebert Smith, LICENSED OPTICIAN
• Ronald Kenneth Smith Sr., PA-C
• Rosalyn J. Smith, LPC
• Sarah Arcara Smith, PA-C
• Sarah Moran Smith, MSW, LCSWA
• Shalorene Smith
• Shannon M. Smith

• Sports Physician Chiropractor in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Sports Physician Chiropractor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.