Individual provider Active NPI

Marie Nicole Smith, RN, CNS

  • Psychiatric/Mental Health Clinical Nurse Specialist
  • Troy, OH
National Provider Identifier
1265711170
Registry record updated Apr 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Clinical Nurse SpecialistTaxonomy code 364SP0808X
License
APRNCNP026015 Issued in OH
Practice address
600 W Main St Ste 130
Troy, OH 45373-3384
Phone
(855) 500-2873
Fax
(937) 980-7057
NPI assigned
Aug 9, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2025

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X APRNCNP026015 OH
Perinatal Nurse Practitioner 363LP1700X APRN..CNP.12269 OH
Clinical Nurse Specialist 364S00000X COA12269NS OH
Adult Health Clinical Nurse Specialist 364SA2200X RN312421 OH
Psychiatric/Mental Health Clinical Nurse Specialist 364SP0808X APRNCNP026015 OH Primary

Addresses

Primary practice location

600 W Main St Ste 130
Troy, OH 45373-3384

Mailing address

3700 Southern Blvd Ste 401
Kettering, OH 45429-1265
Phone (855) 500-2873

Other practice location 1

3737 Southern Blvd
Suite 3200
Kettering, OH 45429-1262
Phone (937) 558-3500

Other identifiers 2

IdentifierTypeStateIssuer
COA12269NSOtherOHOHIO LICENSE
0083654MedicaidOH

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address msmith517890@direct.ketteringhealth.org
FHIR URL https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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 1

Enrollment IDStateProvider typePAC IDDetails
I20130618000579 OH Practitioner - Certified Clinical Nurse Specialist (CNS) 7911146246 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Clinical Nurse Specialist (CNS)
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Kettering Independent Medical Group IncGroup PAC ID 3173710936, 699 clinicians

Practice addresses (Care Compare)

1010 Cereal Ave
Suite 300
Hamilton, OH 45013-2789
Phone (855) 500-2873

3535 Pentagon Blvd
Beavercreek, OH 45431-1705

3535 Pentagon Park Blvd
Suite 400
Dayton, OH 45431-1705
Phone (937) 490-2264

3700 Southern Blvd
Kettering, OH 45429-1265

4403 Far Hills Ave
Kettering, OH 45429-2405
Phone (937) 433-5309

4441 Far Hills Ave
Kettering, OH 45429-2405
Phone (937) 298-7751

Hospital & facility affiliations

  • Kettering Health Dayton Hospital, Dayton, OH, CCN 360133
  • Fort Hamilton Hughes Memorial Hospital Hospital, Hamilton, OH, CCN 360132

Merit-based Incentive Payment System (MIPS)

Final score
81.34 of 100Reported as group
Quality
63.67
Promoting interoperability
100
Improvement activities
40
Cost
74.14

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Specialist, Registered Nurse

State licenses

LicenseStateTypeSpecialty
APRN..CNP.12269OHMDPerinatal Nurse Practitioner
COA12269NSOHMDClinical Nurse Specialist
RN312421OHMDAdult Health Clinical Nurse Specialist
APRNCNP026015OHMDPsychiatric/Mental Health Clinical Nurse Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Kettering Independent Medical Group Inc CurrentSince Dec 29, 2022 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

4403 Far Hills Ave
Kettering, OH 45429
Phone (937) 395-3910

3700 Southern Blvd
Ste 401
Kettering, OH 45429
Phone (855) 500-2873

3737 Southern Blvd
Ste 3200
Kettering, OH 45429
Phone (937) 297-8253

1 Prestige Pl
Ste 550
Miamisburg, OH 45342
Phone (937) 752-2306

2110 Leiter Rd
Miamisburg, OH 45342
Phone (937) 384-4838

600 W Main St
Ste 130
Troy, OH 45373
Phone (855) 500-2873

Organizations & group practices 2

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 2

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": "1312848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743465600000",
    "number": "1265711170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3700 SOUTHERN BLVD STE 401",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454291265",
            "telephone_number": "855-500-2873",
            "fax_number": "937-281-3913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 W MAIN ST STE 130",
            "city": "TROY",
            "state": "OH",
            "postal_code": "453733384",
            "telephone_number": "855-500-2873",
            "fax_number": "937-980-7057"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3737 Southern Blvd",
            "address_2": "Suite 3200",
            "address_purpose": "LOCATION",
            "city": "Kettering",
            "state": "OH",
            "postal_code": "454291262",
            "country_code": "US",
            "telephone_number": "937-558-3500",
            "fax_number": "937-558-5507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MARIE",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "RN, CNS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-09",
        "last_updated": "2025-04-01",
        "certification_date": "2025-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OH",
            "license": "APRNCNP026015",
            "primary": false
        },
        {
            "code": "363LP1700X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Perinatal",
            "state": "OH",
            "license": "APRN..CNP.12269",
            "primary": false
        },
        {
            "code": "364S00000X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist",
            "state": "OH",
            "license": "COA12269NS",
            "primary": false
        },
        {
            "code": "364SA2200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Adult Health",
            "state": "OH",
            "license": "RN312421",
            "primary": false
        },
        {
            "code": "364SP0808X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": "OH",
            "license": "APRNCNP026015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO LICENSE",
            "identifier": "COA12269NS",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0083654",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "msmith517890@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "3700 Southern Blvd Ste 401",
            "city": "Kettering",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454291265",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "3700 Southern Blvd Ste 401",
            "city": "Kettering",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454291265",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Troy, OH

Sources for this page

Verify at the official NPI Registry.