NPIMap

Jennifer Hale Smith, M.D.

Individual provider Active NPI Internal Medicine Physician · Sierra Vista, AZ

NPI 1366601932 · NPPES record last updated Mar 17, 2018

Key facts

NPI
1366601932
Entity type
Individual (NPI type 1)
Primary specialty
Internal Medicine Physician 207R00000X
License
41969 (AZ)
Practice address
155 Calle Portal Ste 300
Sierra Vista, AZ 85635-2900
Phone
(520) 459-3011
NPI assigned
Jun 8, 2008
Sex
Female
Sole proprietor
No

Organizations & group practices 23

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.

Medicare Care Compare profile

Specialty
Internal Medicine
Education
Yale University School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Chiricahua Community Health Centers Inc (44 clinicians)

Practice addresses (Care Compare)

10566 N Hwy 191
Elfrida, AZ 85610-9021
Phone (520) 642-2222

1100 N F Ave
Douglas, AZ 85607-1919
Phone (502) 364-3285

155 Calle Portal
Suite 700
Sierra Vista, AZ 85635-2973
Phone (520) 364-6852

251 W Rex Allen Dr
Willcox, AZ 85643-0066
Phone (520) 364-1429

335 S Ocotillo Ave
Benson, AZ 85602-6406
Phone (520) 864-4040

815 E 15TH St
Douglas, AZ 85607-1631
Phone (520) 364-5437

Hospital & facility affiliations

  • Home Health Safford, LLC Home health agency · Safford, AZ · CCN 037815
  • Northern Cochise Community Hospital, Inc. Hospital · Willcox, AZ · CCN 031302
  • Benson Hospital Hospital · Benson, AZ · CCN 031301
  • Tucson Medical Center Hospital · Tucson, AZ · CCN 030006

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in TX, AZ
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20100323000713 TX Practitioner - Internal Medicine 5991830499 Reassigns benefits to 4 organizations
I20180221001791 AZ Practitioner - Internal Medicine 5991830499 Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
978865432OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Chiricahua Community Health Centers, Inc Current
since Mar 5, 2018		 Accepting new patients
Ton Santa Rosa Health Center Current
since Jan 28, 2010		 Accepting new patients
Chiricahua Community Health Centers, Inc. Current
since Mar 5, 2018		 Accepting new patients
Chiricahua Community Health Centers, Inc Current Accepting new patients
Ton San Simon Health Center Current
since Jan 28, 2010		 Accepting new patients
Ton San Xavier Health Center Current
since Jan 28, 2010		 Accepting new patients
Ton Sells Hospital Current
since Jan 28, 2010		 Accepting new patients
Ton Sells Hospital Past Accepting new patients
Ton San Xavier Health Center Past Accepting new patients
Ton Santa Rosa Health Center Past Accepting new patients

Locations

335 S Ocotillo St
Benson, AZ 85602
Phone (520) 326-4811

108 Arizona St
Bisbee, AZ 85603
Phone (520) 432-3309

1151 E 16th St
Douglas, AZ 85607
Phone (520) 364-5437

1205 N F Ave
Douglas, AZ 85607
Phone (520) 364-6852

1100 N F Ave
Douglas, AZ 85607
Phone (520) 364-3285

1111 N F Ave
Douglas, AZ 85607
Phone (520) 364-6860

815 E 15th St
Douglas, AZ 85607
Phone (520) 364-5437

10566 N Highway 191
Elfrida, AZ 85610
Phone (520) 642-2222

155 Calle Portal
Ste 700
Sierra Vista, AZ 85635
Phone (520) 459-0203

155 Calle Portal
Ste 300
Sierra Vista, AZ 85635
Phone (520) 458-6331

7900 S J Stock Rd
Tucson, AZ 85746
Phone (520) 295-2550

251 W Rex Allen Dr
Willcox, AZ 85643

Interoperability endpoints

  • Direct secure messaging: jennifer.smith.p1@direct.cchci.nextgenshare.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 978865432 OH
Internal Medicine Physician 207R00000X 41969 AZ Yes

Addresses

Primary practice location

155 Calle Portal Ste 300
Sierra Vista, AZ 85635-2900

Mailing address

155 Calle Portal Ste 300
Sierra Vista, AZ 85635-2900

Other practice location 1

3535 Olentangy River Rd
Riverside Methodist Hospital
Columbus, OH 43214-3908
Phone (614) 566-5456

Other practice location 2

3535 Olentangy River Rd
Riverside Methodist Hospital
Columbus, OH 43214-3908
Phone (614) 566-5456

Other practice location 3

1205 F Ave
Douglas, AZ 85607-1920
Phone (520) 364-1429

Other practice location 4

1205 F Ave
Douglas, AZ 85607-1920
Phone (520) 364-1429

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 17, 2018.

{
    "created_epoch": "1212883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1366601932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 CALLE PORTAL STE 300",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856352900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 CALLE PORTAL STE 300",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856352900",
            "telephone_number": "520-459-3011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3535 Olentangy River Rd",
            "address_2": "Riverside Methodist Hospital",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432143908",
            "country_code": "US",
            "telephone_number": "614-566-5456",
            "fax_number": "614-566-6852",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3535 Olentangy River Rd",
            "address_2": "Riverside Methodist Hospital",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432143908",
            "country_code": "US",
            "telephone_number": "614-566-5456",
            "fax_number": "614-566-6852",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1205 F Ave",
            "address_purpose": "LOCATION",
            "city": "Douglas",
            "state": "AZ",
            "postal_code": "856071920",
            "country_code": "US",
            "telephone_number": "520-364-1429",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1205 F Ave",
            "address_purpose": "LOCATION",
            "city": "Douglas",
            "state": "AZ",
            "postal_code": "856071920",
            "country_code": "US",
            "telephone_number": "520-364-1429",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JENNIFER",
        "middle_name": "HALE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-08",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "978865432",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "41969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sierra Vista, AZ

All providers in Sierra Vista, AZ · Internal Medicine Physician in Arizona

Sources for this page

Verify at the official NPI Registry.