NPIMap

Individual provider Active NPI

Jevin Allen Smith, MD

  • Anesthesiology Physician
  • Conway, AR
National Provider Identifier
1346469681
Registry record updated Dec 4, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
E-5962 Issued in AR
Practice address
525 Western Ave
Suite 201
Conway, AR 72034-4967
Phone
(501) 327-6665
Fax
(501) 730-0289
NPI assigned
Apr 25, 2007
Last updated
Dec 4, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X E-5962 AR Primary

Addresses

Primary practice location

525 Western Ave
Suite 201
Conway, AR 72034-4967

Mailing address

525 Western Ave
Suite 201
Conway, AR 72034-4967
Phone (501) 327-6665

Other identifiers 2

IdentifierTypeStateIssuer
E-5962OtherARSTATE MEDICAL LICENSE
5H894OtherBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20090820000465 AR Practitioner - Anesthesiology 6901950252 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Arkansas College of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Conway Anesthesiology Consultants, PAGroup PAC ID 6901796267, 22 clinicians

Practice addresses (Care Compare)

2302 College Ave
Conway, AR 72034-6297
Phone (501) 327-6665

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Conway Regional Medical Center Inc CurrentSince Jan 8, 2018 Accepting new patients
Conway Anesthesiology Consultants, P.a. Anesthesiology CurrentSince Jun 30, 2009 Accepting new patients
Conway Regional Medical Center, Inc. Current Accepting new patients
Conway Regional Medical Center, Inc CurrentSince Jan 8, 2018 Accepting new patients

Locations

2200 Ada Ave
Ste 301
Conway, AR 72034
Phone (501) 358-6560

2302 College Ave
Conway, AR 72034
Phone (501) 329-3831

525 Western Ave
Ste 201
Conway, AR 72034
Phone (501) 327-1727

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 6

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": "1177459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1259884800000",
    "number": "1346469681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 WESTERN AVE",
            "address_2": "SUITE 201",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720344967",
            "telephone_number": "501-327-6665",
            "fax_number": "501-730-0289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 WESTERN AVE",
            "address_2": "SUITE 201",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720344967",
            "telephone_number": "501-327-6665",
            "fax_number": "501-730-0289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JEVIN",
        "middle_name": "ALLEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-25",
        "last_updated": "2009-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AR",
            "license": "E-5962",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "E-5962",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5H894",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, AR

Sources for this page

Verify at the official NPI Registry.