Individual provider Active NPI

Tierra Q Smith, FNP-BC

  • Family Nurse Practitioner
  • East Saint Louis, IL
National Provider Identifier
1316647753
Registry record updated May 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209027198 Issued in IL
Practice address
100 N 8TH St Ste 120
East Saint Louis, IL 62201-2989
Phone
(618) 274-9105
Fax
(618) 274-9101
NPI assigned
Mar 6, 2023
Last updated
May 1, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2023007983 MO
Family Nurse Practitioner 363LF0000X 209027198 IL Primary

Addresses

Primary practice location

100 N 8TH St Ste 120
East Saint Louis, IL 62201-2989

Mailing address

100 N 8TH St Ste 120
East Saint Louis, IL 62201-2989
Phone (618) 274-9105

Other practice location 1

2001 State St
East Saint Louis, IL 62205-1803
Phone (618) 271-0204

Other practice location 2

100 N 8th St Ste 120
East Saint Louis, IL 62201-2989
Phone (618) 274-9105

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tierra.smith.1@9559.direct.athenahealth.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240605002089 IL Practitioner - Nurse Practitioner 1850833823 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2001 State St
East Saint Louis, IL 62205-1803
Phone (618) 271-9191

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209027198ILMDFamily Nurse Practitioner
2023007983MOMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Illinois Healthcare Foundation, Inc. CurrentSince Apr 7, 2024 Accepting new patients
Southern Illinois Healthcare Foundation Inc CurrentSince Dec 1, 2024 Accepting new patients
Southern Illinois Healthcare Foundation Inc CurrentSince Apr 7, 2024 Accepting new patients
Board of Trustees of Southern Illinois University PastSince Feb 1, 2024 Accepting new patients

Locations

100 N 8th St
Ste 120
East Saint Louis, IL 62201
Phone (618) 274-9105

2001 State St
East St Louis, IL 62205
Phone (618) 271-0204

2041 Goose Lake Rd
Sauget, IL 62206

Interoperability endpoints

  • Direct secure messaging: tierra.smith.1@9559.direct.athenahealth.com

Organizations & group practices 4

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1678060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746057600000",
    "number": "1316647753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N 8TH ST STE 120",
            "city": "EAST SAINT LOUIS",
            "state": "IL",
            "postal_code": "622012989",
            "telephone_number": "618-274-9105",
            "fax_number": "618-274-9101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N 8TH ST STE 120",
            "city": "EAST SAINT LOUIS",
            "state": "IL",
            "postal_code": "622012989",
            "telephone_number": "618-274-9105",
            "fax_number": "618-274-9101"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2001 State St",
            "address_purpose": "LOCATION",
            "city": "East Saint Louis",
            "state": "IL",
            "postal_code": "622051803",
            "country_code": "US",
            "telephone_number": "618-271-0204",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 N 8th St Ste 120",
            "address_purpose": "LOCATION",
            "city": "East Saint Louis",
            "state": "IL",
            "postal_code": "622012989",
            "country_code": "US",
            "telephone_number": "618-274-9105",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "TIERRA",
        "middle_name": "Q",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-06",
        "last_updated": "2025-05-01",
        "certification_date": "2025-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2023007983",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209027198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tierra.smith.1@9559.direct.athenahealth.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "2001 State St",
            "city": "East Saint Louis",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622051803",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in East Saint Louis, IL

Sources for this page

Verify at the official NPI Registry.