NPIMap

Individual provider Active NPI

Tommie S Smith, PA-C

  • Physician Assistant
  • Carbondale, IL
National Provider Identifier
1265635957
Registry record updated Nov 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085-002322 Issued in IL
Practice address
2601 W Main St
Carbondale, IL 62901-1031
Phone
(618) 549-5361
Fax
(618) 351-4878
NPI assigned
Jun 8, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085-002322 IL Primary

Addresses

Primary practice location

2601 W Main St
Carbondale, IL 62901-1031

Mailing address

PO Box 3988
Carbondale, IL 62902-3988
Phone (618) 457-5200

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tsmith13682@sih.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20080625000124 IL Practitioner - Physician Assistant 2466523089 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Deaconess Illinois Specialty Clinic, Inc.Group PAC ID 9830562016, 145 clinicians

Practice addresses (Care Compare)

303 S Commercial St
Harrisburg, IL 62946-2125
Phone (618) 767-6050

3331 W Deyoung St
Marion, IL 62959-5896
Phone (618) 998-7600

Hospital & facility affiliations

  • Heartland Regional Medical Center Hospital, Marion, IL, CCN 140184
  • Deaconess Illinois Crossroads Hospital, Mount Vernon, IL, CCN 140294
  • Deaconess Illinois Union County Hospital, Anna, IL, CCN 141342
  • Memorial Hospital of Carbondale Hospital, Carbondale, IL, CCN 140164
  • Herrin Hospital Hospital, Herrin, IL, CCN 140011

Merit-based Incentive Payment System (MIPS)

Final score
77.51 of 100Reported as group
Quality
49.04
Promoting interoperability
95
Improvement activities
40
Cost
69.42

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085-002322ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Deaconess Illinois Specialty Clinic, Inc. Physician Assistant CurrentSince Jan 14, 2023 Accepting new patients
Southern Illinois Medical Services, NFP CurrentSince Apr 7, 2009 Accepting new patients
Deaconess Illinois Specialty Clinic, Inc. Physician Assistant CurrentSince Jan 14, 2023 Accepting new patients
Deaconess Illinois Clinic, Inc Past Accepting new patients
Memorial Management Inc Past Accepting new patients

Locations

2601 W Main St
Carbondale, IL 62901
Phone (618) 351-7300

305 W Jackson St
Ste 301
Carbondale, IL 62901
Phone (618) 529-0520

303 S Commercial St
Harrisburg, IL 62946
Phone (618) 767-6050

3331 W Deyoung St
Marion, IL 62959
Phone (618) 985-9140

Interoperability endpoints

  • Direct secure messaging: tsmith22@yourcarecommunity.org
  • Direct secure messaging: tsmith423553@direct.deaconess.com
  • Direct secure messaging: tommie.smith.1@27782.direct.athenahealth.com

Organizations & group practices 8

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1181260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604275200000",
    "number": "1265635957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3988",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629023988",
            "telephone_number": "618-457-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 W MAIN ST",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011031",
            "telephone_number": "618-549-5361",
            "fax_number": "618-351-4878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "TOMMIE",
        "middle_name": "S",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-08",
        "last_updated": "2020-11-02",
        "certification_date": "2020-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-002322",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tsmith13682@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "2601 W Main St",
            "city": "Carbondale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629011031",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Carbondale, IL

Sources for this page

Verify at the official NPI Registry.