Active NPI
Dennis Jason Smoak, PA
- Physician Assistant
- Dothan, AL
National Provider Identifier
1275516825
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA434
- Practice address
- 2431 W Main St Ste 1001
Dothan, AL 36301-6404 - Phone
- (334) 794-2825
- Fax
- (344) 793-5050
- NPI assigned
- Nov 28, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA434 | AL | Primary |
Addresses
Primary practice location
2431 W Main St Ste 1001
Dothan, AL 36301-6404
Mailing address
2431 W Main St Ste 1001
Dothan, AL 36301-6404
Phone (334) 794-2825
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 515-31347 | Other | AL | BCBS-1108 ROSS CLARK |
| 515-31348 | Other | AL | BCBS-4370 W MAIN ST |
| 515-31346 | Other | AL | BCBS-1900 FAIRVIEW |
| 515-31349 | Other | AL | BCBS-400 N EDWARDS |
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: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1275516825",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2431 W MAIN ST STE 1001",
"city": "DOTHAN",
"state": "AL",
"postal_code": "363016404",
"telephone_number": "334-794-2825",
"fax_number": "334-793-5050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2431 W MAIN ST STE 1001",
"city": "DOTHAN",
"state": "AL",
"postal_code": "363016404",
"telephone_number": "334-794-2825",
"fax_number": "344-793-5050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMOAK",
"first_name": "DENNIS",
"middle_name": "JASON",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AL",
"license": "PA434",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS-1108 ROSS CLARK",
"identifier": "515-31347",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS-4370 W MAIN ST",
"identifier": "515-31348",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS-1900 FAIRVIEW",
"identifier": "515-31346",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS-400 N EDWARDS",
"identifier": "515-31349",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dothan, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.