Kevin Ray Smith, MD

Primary specialty

Geriatric Psychiatry PhysicianTaxonomy code 2084P0805X

License

MD18891 Issued in OR

Practice address

3181 SW Sam Jackson Park Rd
Up
Portland, OR 97239-3011

Phone

(503) 494-8617

NPI assigned

Aug 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Geriatric Psychiatry Associates Northwest, P.C.

  • Geriatric Psychiatry Physician
  • Portland, OR
  • NPI 1760674071
  NPD (past) Authorized official

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366450801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1231 NE M L KING BLVD APT 601",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD",
            "address_2": "UP",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393011",
            "telephone_number": "503-494-8617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KEVIN",
        "middle_name": "RAY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "OR",
            "license": "MD18891",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "151231",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelly Smith, MSW
• Kelly Anne Smith, L.M.T.
• Kelsie C Smith, CCC-SLP
• Kevin Smith, PHARMD, RPH
• Kevin Smith
• Kimberly Jan Smith, P.T.
• Kristina Smith, LMT
• Kyle Christopher Smith
• Ladonna Marie Smith
• Laura H Smith, PSYD

• Geriatric Psychiatry Physician in Portland, OR
• Providers in Portland, OR by specialty
• Geriatric Psychiatry Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.