Individual provider Active NPI

Samone D. Smith, PA-C

  • Physician Assistant
  • Killeen, TX
National Provider Identifier
1366593956
Registry record updated Dec 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA05059 Issued in TX
Practice address
2405 S Clear Creek Rd
Killeen, TX 76549-5775
Phone
(254) 618-1888
Fax
(254) 519-5264
NPI assigned
Jan 12, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA05059 TX Primary

Addresses

Primary practice location

2405 S Clear Creek Rd
Killeen, TX 76549-5775

Mailing address

PO Box 844658
Dallas, TX 75284-4658
Phone (254) 727-2111

Other practice location 1

5200 Harry Hines Blvd
Dallas, TX 75235-7709
Phone (214) 590-8000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ssmith636899@direct.sw.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20070215000175 TX Practitioner - Physician Assistant 0749282069 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Healthtexas Provider NetworkGroup PAC ID 1355254210, 2,535 clinicians

Practice addresses (Care Compare)

12230 Coit Rd
Suite 100
Dallas, TX 75251-2323
Phone (214) 252-7020

3500 Gaston Ave
FL 1
Dallas, TX 75246-2017
Phone (972) 817-6100

4001 Worth St
Dallas, TX 75246-1608

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA05059TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Healthtexas Provider Network CurrentSince Dec 6, 2021 Accepting new patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Apr 16, 2018 Accepting new patients
University of Texas Southwestern Medical Center at Dallas CurrentSince Apr 16, 2018 Accepting new patients
Healthtexas Provider Network CurrentSince Dec 6, 2021 Accepting new patients
Al Mollabashy, MD, PA Past Accepting new patients
MCH Professional Care Past Accepting new patients
Nathan F Gilbert, MD, PA Past Accepting new patients

Locations

4001 Worth St
Dallas, TX 75246
Phone (214) 828-1745

3900 Junius St
Ste 500
Dallas, TX 75246
Phone (214) 823-7090

12230 Coit Rd
Ste 100
Dallas, TX 75251
Phone (214) 252-7020

301 N Washington Ave
Dallas, TX 75246
Phone (469) 800-8330

4001 Worth St
#A
Dallas, TX 75246
Phone (214) 820-8665

5201 Harry Hines Blvd
Dallas, TX 75235
Phone (214) 590-1396

3000 N Interstate 35
Denton, TX 76201
Phone (469) 303-3591

Interoperability endpoints

  • Direct secure messaging: ssmith636899@direct.sw.org

Organizations & group practices 8

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.

Hospital & facility affiliations 4

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": "1168560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670457600000",
    "number": "1366593956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658",
            "telephone_number": "254-727-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2405 S CLEAR CREEK RD",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765495775",
            "telephone_number": "254-618-1888",
            "fax_number": "254-519-5264"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5200 Harry Hines Blvd",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752357709",
            "country_code": "US",
            "telephone_number": "214-590-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "SAMONE",
        "middle_name": "D.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-12",
        "last_updated": "2022-12-08",
        "certification_date": "2022-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA05059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ssmith636899@direct.sw.org",
            "affiliation": "N",
            "address_1": "12230 Coit Rd Ste 100",
            "city": "Dallas",
            "state": "TX",
            "country_code": "US",
            "postal_code": "752512323",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Killeen, TX

Sources for this page

Verify at the official NPI Registry.