Individual provider Active NPI

McCrae Sidney Smith, MD

  • Neonatal-Perinatal Medicine Physician
  • Greensboro, NC
National Provider Identifier
1295779619
Registry record updated Dec 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
31102 Issued in NC
Practice address
628 Green Valley Rd
Suite 210
Greensboro, NC 27408-7730
Phone
(336) 478-1016
Fax
(336) 851-1737
NPI assigned
Jun 15, 2006
Last updated
Dec 14, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 31102 NC
Neonatal-Perinatal Medicine Physician 2080N0001X 31102 NC Primary

Addresses

Primary practice location

628 Green Valley Rd
Suite 210
Greensboro, NC 27408-7730

Mailing address

628 Green Valley Rd
Suite 210
Greensboro, NC 27408-7730
Phone (336) 478-1016

Other identifiers 4

IdentifierTypeStateIssuer
42911OtherNCMEDCOST
77973OtherNCBCBS NC
8977973MedicaidNC
4336735OtherNCAETNA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140514000654 NC Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 5799908026

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Piedmont Neonatology PC Neonatal-Perinatal Medicine Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323820800000",
    "number": "1295779619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "628 GREEN VALLEY RD",
            "address_2": "SUITE 210",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274087730",
            "telephone_number": "336-478-1016",
            "fax_number": "336-851-1737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "628 GREEN VALLEY RD",
            "address_2": "SUITE 210",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274087730",
            "telephone_number": "336-478-1016",
            "fax_number": "336-851-1737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MCCRAE",
        "middle_name": "SIDNEY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2011-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "31102",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "NC",
            "license": "31102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "42911",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NC",
            "identifier": "77973",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8977973",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4336735",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, NC

Sources for this page

Verify at the official NPI Registry.