Kelly Smith

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

307972 Issued in NY

Practice address

4455 Macarthur Blvd NW
Apt 106
Washington, DC 20007-2552

Phone

(413) 219-1854

NPI assigned

Mar 20, 2017

Last updated

May 6, 2021By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Networks

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

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.

• North Shore Medical Group of the Mount Sinai School of Medicine

  dba Mount Sinai Doctors Long Island

  • Internal Medicine Physician
  • Greenlawn, NY
  • NPI 1275640609
  Medicare reassignment NPD
• North Shore Medical Group of the Mount Sinai School of Medicine

  • Internal Medicine Physician
  • Wantagh, NY
  • NPI 1992417323

  Pediatrics

  NPD

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

{
    "created_epoch": "1489968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620259200000",
    "number": "1346781564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2520 30TH AVE",
            "address_2": "FL 4",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111022448",
            "telephone_number": "718-808-7777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4455 MACARTHUR BLVD NW",
            "address_2": "APT 106",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200072552",
            "telephone_number": "413-219-1854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KELLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-20",
        "last_updated": "2021-05-06",
        "certification_date": "2021-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "307972",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaylah Smith
• Keann Smith
• Kelby Smith
• Kelley Jenean Smith
• Kellie Smith
• Kelly Nicole Smith, LICSW, LCSW
• Keniah Nigel Smith
• Kenneth Edward Smith
• Kerianne Smith, DNP, FNP-C
• Kevin Smith, DO

• Pediatrics Physician in Washington, DC
• Providers in Washington, DC by specialty
• Pediatrics Physician in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2021; 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.