Active NPI
John M Smith, MD.
- Emergency Medicine Physician
- Fort Mitchell, KY
National Provider Identifier
1306860424
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 21523
- Practice address
- 78 Sunnymede Dr
Fort Mitchell, KY 41017-2842 - Phone
- (859) 331-6104
- NPI assigned
- Jul 26, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 21523 | KY | Primary |
| General Practice Physician | 208D00000X | 35092296 | OH |
Addresses
Primary practice location
78 Sunnymede Dr
Fort Mitchell, KY 41017-2842
Mailing address
78 Sunnymede Dr
Fort Mitchell, KY 41017-2842
Phone (859) 331-6104
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64215239 | Medicaid | KY | |
| 0598367 | Medicaid | OH |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21523 | KY | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Skin Cancer Center Inc | 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 and National Provider Directory roles.
-
- Ambulatory Surgical Clinic/Center
- Cincinnati, OH
- NPI 1871526004
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364774400000",
"number": "1306860424",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "78 SUNNYMEDE DR",
"city": "FORT MITCHELL",
"state": "KY",
"postal_code": "410172842",
"telephone_number": "859-331-6104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "78 SUNNYMEDE DR",
"city": "FORT MITCHELL",
"state": "KY",
"postal_code": "410172842",
"telephone_number": "859-331-6104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "JOHN",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "MD.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-26",
"last_updated": "2013-04-01",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "KY",
"license": "21523",
"primary": true
},
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "OH",
"license": "35092296",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64215239",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0598367",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Mitchell, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.