Roger D Smith, DMD PSC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4241 Issued in KY

Practice address

933 Russell Rd Ste 103
Columbia, KY 42728-1054

Phone

(270) 384-5155

Fax

(270) 384-6757

NPI assigned

Oct 3, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1220313600000",
    "number": "1245324904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "933 RUSSELL RD STE 103",
            "city": "COLUMBIA",
            "state": "KY",
            "postal_code": "427281054",
            "telephone_number": "270-384-5155",
            "fax_number": "270-384-6757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "933 RUSSELL RD STE 103",
            "city": "COLUMBIA",
            "state": "KY",
            "postal_code": "427281054",
            "telephone_number": "270-384-5155",
            "fax_number": "270-384-6757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "ROGER",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DMD PSC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2008-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "4241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert S. Shipp, M.D.
• Thomas Richard Simac
• Gary Simons
• Huston Chase Smith, BA
• Jennica Smith
• Spectrum Care Academy Bluegrass I
• Spectrum Care Academy Bluegrass II
• Spectrum Care Academy, Inc.
• Spectrum Care Academy, Inc.
• Sherry Lynn Spires, LPN

• General Practice Dentistry in Columbia, KY
• Providers in Columbia, KY by specialty
• General Practice Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.