Active NPI
Kevin James Smith
- Internal Medicine Physician
- Syracuse, NY
National Provider Identifier
1265869648
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 342581
- Practice address
- 750 E Adams St
Syracuse, NY 13210-1834 - Phone
- (315) 464-5240
- NPI assigned
- Oct 1, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 342581 | NY | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Physician Assistant | 363A00000X | 017009 | NY |
Addresses
Primary practice location
750 E Adams St
Syracuse, NY 13210-1834
Mailing address
750 E Adams St
Syracuse, NY 13210-1834
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03739291 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 017009 | NY | MD | Massage Therapist |
Interoperability endpoints
- ksmith117265@direct.upstate.edu
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1380585600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1789084800000",
"number": "1265869648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "750 E ADAMS ST",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132101834"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "750 E ADAMS ST",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132101834",
"telephone_number": "315-464-5240"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "KEVIN",
"middle_name": "JAMES",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-10-01",
"last_updated": "2026-09-11",
"certification_date": "2026-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NY",
"license": "342581",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "017009",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "03739291",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Syracuse, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2026; 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.