Ksenia Smirnov, CRNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

SP012947 Issued in PA

Practice address

9880 Bustleton Ave
Suite 208
Philadelphia, PA 19115-2185

Phone

(215) 677-0667

Fax

(215) 677-1063

NPI assigned

Jul 2, 2013

Last updated

Jul 2, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

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.

• Avellina Inc.

  • Internal Medicine Physician
  • Philadelphia, PA
  • NPI 1285805507
  Medicare reassignment NPD

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

{
    "created_epoch": "1372723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372723200000",
    "number": "1346680519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 MASON DR",
            "city": "WARMINSTER",
            "state": "PA",
            "postal_code": "189742706",
            "telephone_number": "267-243-0671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9880 BUSTLETON AVE",
            "address_2": "SUITE 208",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191152185",
            "telephone_number": "215-677-0667",
            "fax_number": "215-677-1063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMIRNOV",
        "first_name": "KSENIA",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-02",
        "last_updated": "2013-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "PA",
            "license": "SP012947",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Smiles Art Inc
• Smiles for Miles Dental Group
• Megan Lea Smiley, LPC
• Stephanie Smiley, CRNP
• Smiling Hands Homecare, LLC
• Anthony D Smith Jr
• Smith Medical PC
• Kiwanna Smith Scott, LPN
• Krista Samantha Smith-Hanke, MSS, LSW
• Coretha Smith-Johnson, MASTER PUBLIC HEALTH

• Adult Health Nurse Practitioner in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Adult Health Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.