Michel E Hanen Smith, O.D., M..S

Primary specialty

OptometristTaxonomy code 152W00000X

License

LD1652000 Issued in MN

Practice address

4323 E Lake St
Minneapolis, MN 55406-2307

Phone

(612) 722-1003

Fax

(612) 721-6331

NPI assigned

Nov 13, 2006

Last updated

Dec 27, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 12

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Indiana University - School of Optometry, 1975

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

River Lake Clinic LLCGroup PAC ID 3173749322, 3 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

87.82 of 100Reported as group

Quality

68.32

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mikehanen-smith@direct.revolutionehr.com

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.

• River Lake Clinic LLC

  dba River Lake Clinic

  • Optometrist
  • Minneapolis, MN
  • NPI 1902932965
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1388102400000",
    "number": "1326119223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4323 E LAKE ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554062307",
            "telephone_number": "612-722-1003",
            "fax_number": "612-721-6336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4323 E LAKE ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554062307",
            "telephone_number": "612-722-1003",
            "fax_number": "612-721-6331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANEN SMITH",
        "first_name": "MICHEL",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "O.D., M..S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2013-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "LD1652000",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "MN",
            "license": "LD1652000",
            "primary": false
        },
        {
            "code": "152WX0102X",
            "taxonomy_group": "",
            "desc": "Optometrist, Occupational Vision",
            "state": "MN",
            "license": "LD1652000",
            "primary": false
        },
        {
            "code": "152WX0102X",
            "taxonomy_group": "",
            "desc": "Optometrist, Occupational Vision",
            "state": "ND",
            "license": "362",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "00621001",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BSBC OF WI",
            "identifier": "411459852017",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "333023100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLINIC BCBS",
            "identifier": "06314HA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MODIRA UNITED HEALTH CARE",
            "identifier": "2202691",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA PRIMARY",
            "identifier": "2202001",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DURABLE GOODS DMERC",
            "identifier": "0748240001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PIN HEALTH PARTNERS",
            "identifier": "19312",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE PLUS",
            "identifier": "5C003HA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "101856",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL DISP",
            "identifier": "2115985",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER BCBS",
            "identifier": "3M197HA",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Danielle Marie Hance, MA, LMHC
• Steven Casey Hand, M.D.
• Taylor W Hand, MD
• Hillary Handler, PHD, CGC, LGC
• Jessica Hane, M.D.
• Joshua Jessie Dewar Smith Hanen, JD, OD, FAAO
• Kimberly Hanenberger, CRNA
• Lindsay Nicole Hanenburg, LICSW
• Ernest Taijin Hanes, DO
• Kennedy Haney-Goelz, MS RDN LD

• Optometrist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.