NPIMap

Individual provider Active NPI

Marybeth Smith, APN, FNP-C

  • Family Nurse Practitioner
  • Bolivar, OH
National Provider Identifier
1285934604
Registry record updated May 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
11140 Issued in OH
Practice address
10724 State Route 212 NE
Bolivar, OH 44612-8740
Phone
(330) 874-7165
Fax
(330) 874-7166
NPI assigned
Nov 2, 2010
Sex
Female
Sole proprietor
No

Organizations & group practices 12

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 4

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

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orrville Hospital Foundation 78 clinicians

Practice addresses (Care Compare)

10724 State Route 212 NE
Bolivar, OH 44612-8740
Phone (330) 874-7165

832 S Main St
Orrville, OH 44667-2208
Phone (330) 682-3010

Hospital & facility affiliations

  • Advantage Home Health Services, Inc Home health agency, North Canton, OH, CCN 368248
  • Aultman Health Care in Your Home Home health agency, Canton, OH, CCN 367290
  • Aultman Orrville Hospital Hospital, Orrville, OH, CCN 361323
  • Aultman Hospital Hospital, Canton, OH, CCN 360084

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20150716002625 OH Practitioner - Nurse Practitioner 3476866674 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11140OHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Orrville Hospital Foundation CurrentSince Jul 1, 2020 Accepting new patients
Orrville Hospital Foundation CurrentSince Jul 1, 2020 Accepting new patients
Orrville Hospital Foundation Past Accepting new patients
Orrville Hospital Foundation Past Accepting new patients

Locations

10724 State Route 212 NE
Bolivar, OH 44612
Phone (330) 874-7165

2600 6th St SW
Canton, OH 44710
Phone (330) 363-2180

832 S Main St
Orrville, OH 44667
Phone (330) 456-2695

Interoperability endpoints

  • Direct secure messaging: marybeth.smith@direct.aultman.org

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11140 OH Primary

Addresses

NPPES NPI Registry

Primary practice location

10724 State Route 212 NE
Bolivar, OH 44612-8740

Mailing address

10724 State Route 212 NE
Bolivar, OH 44612-8740
Phone (330) 874-7165

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
0127945MedicaidOH

Other names 1

NPPES NPI Registry
  • Marybeth Baumberger Former name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 23, 2019.

{
    "created_epoch": "1288656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558569600000",
    "number": "1285934604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10724 STATE ROUTE 212 NE",
            "city": "BOLIVAR",
            "state": "OH",
            "postal_code": "446128740",
            "telephone_number": "330-874-7165",
            "fax_number": "330-874-7166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10724 STATE ROUTE 212 NE",
            "city": "BOLIVAR",
            "state": "OH",
            "postal_code": "446128740",
            "telephone_number": "330-874-7165",
            "fax_number": "330-874-7166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MARYBETH",
        "name_prefix": "Mrs.",
        "credential": "APN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-11-02",
        "last_updated": "2019-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "11140",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0127945",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARYBETH",
            "last_name": "BAUMBERGER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Bolivar, OH

Sources for this page

Verify at the official NPI Registry.