Individual provider Active NPI

Lynne W Smith, ANP

  • Nurse Practitioner
  • Ontario, OH
National Provider Identifier
1336123710
Registry record updated Aug 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
06842 Issued in OH
Practice address
1750 W 4TH St
Ontario, OH 44906-1770
Phone
(419) 526-8111
Fax
(419) 526-8114
NPI assigned
Nov 30, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 06842 OH Primary

Addresses

Primary practice location

1750 W 4TH St
Ontario, OH 44906-1770

Mailing address

335 Glessner Ave
Mansfield, OH 44903-2269
Phone (419) 520-2495

Other identifiers 1

IdentifierTypeStateIssuer
2305759MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20040714001600 OH Practitioner - Nurse Practitioner 7618956590 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
06842OHMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ohiohealth Urgent Care LLC CurrentSince Jun 1, 2018 Accepting new patients
Ohiohealth Employer Services, LLC CurrentSince Aug 25, 2019 Accepting new patients
Medcentral Professional Foundation, LLC PastSince Apr 1, 2008 Accepting new patients
Medcentral Professional Association Inc. Past Accepting new patients
Richland Endocrinology & Diabetes Center Inc Past Accepting new patients

Locations

5555 Cleveland Ave
Columbus, OH 43231
Phone (614) 788-5280

Dept L3652
Columbus, OH 43260

6905 Hospital Dr
Ste 130
Dublin, OH 43016
Phone (614) 923-0300

2030 Stringtown Rd
Grove City, OH 43123
Phone (614) 566-0987

1750 W 4th St
Ontario, OH 44906
Phone (419) 520-3530

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472083200000",
    "number": "1336123710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "335 GLESSNER AVE",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449032269",
            "telephone_number": "419-520-2495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 W 4TH ST",
            "city": "ONTARIO",
            "state": "OH",
            "postal_code": "449061770",
            "telephone_number": "419-526-8111",
            "fax_number": "419-526-8114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "LYNNE",
        "middle_name": "W",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-30",
        "last_updated": "2016-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "06842",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2305759",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ontario, OH

Sources for this page

Verify at the official NPI Registry.