NPIMap

Individual provider Active NPI

Kelley R Smith, DO

  • Surgery Physician
  • Du Bois, PA
National Provider Identifier
1336157676
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
OS012962 Issued in PA
Practice address
100 Hospital Ave
Du Bois, PA 15801-1440
Phone
(724) 825-0600
NPI assigned
Aug 3, 2006
Last updated
Mar 17, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X OS012962 PA Primary

Addresses

Primary practice location

100 Hospital Ave
Du Bois, PA 15801-1440

Mailing address

145 Hospital Ave
Du Bois, PA 15801-1462
Phone (814) 375-4000

Other practice location 1

240 Allegheny Blvd Ste A
Brookville, PA 15825-2324
Phone (814) 375-4000

Other identifiers 13

IdentifierTypeStateIssuer
410311OtherPAUPMC FOR LIFE
SM1641016OtherPAHIGHMARK
1539932MedicaidPA
7364643OtherPAAETNA
5235361OtherPACIGNA
14928MedicaidPA
I13444OtherPAHEALTHAMERICA
SM1641016OtherPASECURITY BLUE
158522MedicaidPA
0000246632503OtherPAUNITED HEALTHCARE
I13444OtherPAHEALTHASSURANCE
1011784180001MedicaidPA
I13444OtherPAADVANTRA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20040830000275 PA Practitioner - General Surgery 6800861261 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Philadelphia College of Osteopathic Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dubois Regional Medical CenterGroup PAC ID 5890689715, shared by 39 NPIs, 424 clinicians

Practice addresses (Care Compare)

635 Maple Ave
Dubois, PA 15801-2376
Phone (814) 371-4320

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.6 of 100Reported as group
Promoting interoperability
96
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy16
Hernia repair (minimally invasive)1-10
Mastectomy33
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Dubois Regional Medical Center CurrentSince Oct 1, 2014 Accepting new patients
Dubois Regional Medical Center Surgery CurrentSince Oct 1, 2014 Accepting new patients
Dubois Regional Medical Center Surgery CurrentSince Oct 1, 2014 Accepting new patients
Dubois Regional Medical Center Surgery Past Accepting new patients
Allegheny Clinic Past Accepting new patients
Windber Hospital, Inc. Past Accepting new patients
Jefferson Hills Surgical Specialists Surgery PastSince Jul 1, 2008 Accepting new patients

Locations

240 Allegheny Blvd
Ste A
Brookville, PA 15825
Phone (814) 375-4000

100 Hospital Ave
Dubois, PA 15801
Phone (814) 375-2040

100 Hospital Ave
Ofc
Dubois, PA 15801

145 Hospital Ave
Ste 215
Dubois, PA 15801
Phone (814) 371-1717

145 Hospital Ave
Ste 301
Dubois, PA 15801
Phone (814) 375-4000

145 Hospital Ave
Ste 313
Dubois, PA 15801
Phone (814) 375-4000

271 Railroad St
Philipsburg, PA 16866
Phone (814) 342-1872

Interoperability endpoints

  • Direct secure messaging: krsmith@1285.direct.myezyaccess.com

Organizations & group practices 7

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 49

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

View all 49

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1336157676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 HOSPITAL AVE",
            "city": "DU BOIS",
            "state": "PA",
            "postal_code": "158011462",
            "telephone_number": "814-375-4000",
            "fax_number": "814-375-4011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HOSPITAL AVE",
            "city": "DU BOIS",
            "state": "PA",
            "postal_code": "158011440",
            "telephone_number": "724-825-0600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "240 Allegheny Blvd Ste A",
            "address_purpose": "LOCATION",
            "city": "Brookville",
            "state": "PA",
            "postal_code": "158252324",
            "country_code": "US",
            "telephone_number": "814-375-4000",
            "fax_number": "814-375-4011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KELLEY",
        "middle_name": "R",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-03",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "OS012962",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPMC FOR LIFE",
            "identifier": "410311",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK",
            "identifier": "SM1641016",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1539932",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7364643",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "5235361",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14928",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHAMERICA",
            "identifier": "I13444",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SECURITY BLUE",
            "identifier": "SM1641016",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "158522",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "0000246632503",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHASSURANCE",
            "identifier": "I13444",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1011784180001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADVANTRA",
            "identifier": "I13444",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Du Bois, PA

Sources for this page

Verify at the official NPI Registry.