NPIMap

Individual provider Active NPI

Shannon Smiley, PA-C

  • Physician Assistant
  • Poughkeepsie, NY
National Provider Identifier
1326678426
Registry record updated Mar 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
026963 Issued in NY
Practice address
243 North Rd Ste 204
Poughkeepsie, NY 12601-1173
Phone
(845) 451-7271
Fax
(845) 454-0702
NPI assigned
Jan 17, 2020
Last updated
Mar 18, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA061358 PA
Physician Assistant 363A00000X 026963 NY Primary

Addresses

Primary practice location

243 North Rd Ste 204
Poughkeepsie, NY 12601-1173

Mailing address

243 North Rd Ste 204
Poughkeepsie, NY 12601-1173
Phone (845) 451-7271

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20211210001903 NY Practitioner - Physician Assistant 9032546759 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

243 N Rd
Poughkeepsie, NY 12601-1173

701 N Broadway
Sleepy Hollow, NY 10591-1020
Phone (914) 366-3000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
026963NYMDPharmacist
MA061358PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Care, P.C. CurrentSince Jan 31, 2022 Accepting new patients
Premier Medical Group of the Hudson Valley P.C. CurrentSince Jul 8, 2024 Accepting new patients
Premier Medical Group of the Hudson Valley, P.C. CurrentSince Jul 8, 2024 Accepting new patients

Locations

90 S Bedford Rd
Mount Kisco, NY 10549
Phone (914) 242-1050

243 North Rd
Ste 202
Poughkeepsie, NY 12601
Phone (845) 451-7252

243 North Rd
Ste 204
Poughkeepsie, NY 12601
Phone (845) 451-7271

243 North Rd
Ste 304
Poughkeepsie, NY 12601
Phone (845) 451-7251

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: ssmiley@premiermedicalhv.medentdirect.com

Organizations & group practices 5

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 4

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": "1579219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742256000000",
    "number": "1326678426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "243 NORTH RD STE 204",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126011173",
            "telephone_number": "845-451-7271",
            "fax_number": "845-454-0702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "243 NORTH RD STE 204",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126011173",
            "telephone_number": "845-451-7271",
            "fax_number": "845-454-0702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMILEY",
        "first_name": "SHANNON",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-17",
        "last_updated": "2025-03-18",
        "certification_date": "2025-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA061358",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "026963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Poughkeepsie, NY

Sources for this page

Verify at the official NPI Registry.