Active NPI
Joseph Smith, PHD, ATC
- Athletic Trainer
- Portola Valley, CA
National Provider Identifier
1275998098
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 04042217
- Practice address
- 107 Ramona Rd
Portola Valley, CA 94028-8135 - Phone
- (808) 341-7262
- NPI assigned
- Dec 21, 2015
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 04042217 | CA | Primary |
Addresses
Primary practice location
107 Ramona Rd
Portola Valley, CA 94028-8135
Mailing address
6238 14TH St S
Fargo, ND 58104-7230
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04042217 | CA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1450656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628467200000",
"number": "1275998098",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6238 14TH ST S",
"city": "FARGO",
"state": "ND",
"postal_code": "581047230"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "107 RAMONA RD",
"city": "PORTOLA VALLEY",
"state": "CA",
"postal_code": "940288135",
"telephone_number": "808-341-7262"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "PHD, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-12-21",
"last_updated": "2021-08-09",
"certification_date": "2021-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "CA",
"license": "04042217",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portola Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.