Shane McBride Smith, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

6819 Issued in AZ

Practice address

2200 E Show Low Lake Rd
Show Low, AZ 85901-7831

Phone

(928) 537-4375

NPI assigned

Sep 7, 2017

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

Medicare fee-for-service enrollment

Enrolled in AZ, TX2 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shanesmith@shrmcshma.allscriptsdirect.net

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.

• Winslow Indian Health Care Center, Inc

  • Federal Public Health Clinic/Center
  • Winslow, AZ
  • NPI 1184729493

  TX

  Medicare reassignment NPD
• Summit Healthcare Medical Associates

  • Family Medicine Physician
  • Show Low, AZ
  • NPI 1467878108
  Medicare reassignment
• Innova Emergency Medical Associates PC

  • Emergency Medicine Physician
  • Trinidad, CO
  • NPI 1295178978

  AZ

  Medicare reassignment
• Summit Healthcare Association

  • Rural Acute Care Hospital
  • Show Low, AZ
  • NPI 1144209271

  Physician Assistant

  NPD
• Summit Healthcare Medical Associates

  • Rural Health Clinic/Center
  • Eagar, AZ
  • NPI 1063166999
  NPD
• Summit Healthcare Medical Associates

  • Rural Health Clinic/Center
  • Overgaard, AZ
  • NPI 1770700767
  NPD
• Winslow Indian Health Care Center, Inc

  • Land Ambulance
  • Winslow, AZ
  • NPI 1477827368
  NPD
• Summit Healthcare Medical Associates

  • Rural Health Clinic/Center
  • Show Low, AZ
  • NPI 1942701693
  NPD (past)

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

{
    "created_epoch": "1504742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1504742400000",
    "number": "1255859567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 BREINHOLT LN",
            "city": "SHOW LOW",
            "state": "AZ",
            "postal_code": "85901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 E SHOW LOW LAKE RD",
            "city": "SHOW LOW",
            "state": "AZ",
            "postal_code": "859017831",
            "telephone_number": "928-537-4375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "SHANE",
        "middle_name": "MCBRIDE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-07",
        "last_updated": "2017-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "6819",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cory Shannon Simpson, REGISTERED NURSE/ RN
• Sarah Simpson, LCSW
• Brandi Su Small, PHARMD
• Ashley Marie Smith, FNP-C
• Laurel Smith, NP
• William Smith, LMFT
• Bryan Sean Smithson, MD
• Snoozers Inc
• Michael J Snow, DDS
• Sober Mountain LLC

• Physician Assistant in Show Low, AZ
• Providers in Show Low, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2017; 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.