NPIMap

Individual provider Active NPI

Katelyn Gray Smith, D.O.

  • Sleep Medicine (Psychiatry & Neurology) Physician
  • Port Matilda, PA
National Provider Identifier
1376830612
Registry record updated Aug 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sleep Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084S0012X
License
OS019215 Issued in PA
Practice address
132 Abigail LN
Port Matilda, PA 16870-7153
Phone
(814) 272-7100
Fax
(814) 272-6501
NPI assigned
Jul 7, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 2011019213 MO
Sleep Medicine (Psychiatry & Neurology) Physician 2084S0012X OS019215 PA Primary

Addresses

Primary practice location

132 Abigail LN
Port Matilda, PA 16870-7153

Mailing address

100 N Academy Ave
Danville, PA 17822-4903
Phone (570) 271-6144

Other practice location 1

1438 S Grand Blvd
Saint Louis, MO 63104-1027
Phone (314) 977-4864

Other practice location 2

1438 S Grand Blvd
Saint Louis, MO 63104-1027
Phone (314) 977-4864

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ksmith166591@direct.geisinger.edu Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180607002266 PA Practitioner - Sleep Medicine 7113229592 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Sleep Medicine
Education
Philadelphia College of Osteopathic Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Geisinger ClinicGroup PAC ID 5395657001, 3,432 clinicians

Practice addresses (Care Compare)

100 N Academy Ave
Danville, PA 17822-9800
Phone (570) 271-6144

132 Abigail LN
Port Matilda, PA 16870-7153
Phone (814) 272-7100

517 Ash St
Scranton, PA 18509-2902

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
2011019213MOMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger Clinic CurrentSince Jul 5, 2018 Accepting new patients
Geisinger Clinic Current Accepting new patients
Geisinger Clinic CurrentSince Jul 5, 2018 Accepting new patients
Geisinger Clinic Past Accepting new patients

Locations

100 N Academy Ave
Danville, PA 17822

132 Abigail Ln
Port Matilda, PA 16870
Phone (814) 272-5011

Organizations & group practices 4

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 40

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1309996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598832000000",
    "number": "1376830612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178224903",
            "telephone_number": "570-271-6144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 ABIGAIL LN",
            "city": "PORT MATILDA",
            "state": "PA",
            "postal_code": "168707153",
            "telephone_number": "814-272-7100",
            "fax_number": "814-272-6501"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1438 S Grand Blvd",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631041027",
            "country_code": "US",
            "telephone_number": "314-977-4864",
            "fax_number": "314-977-4876",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1438 S Grand Blvd",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631041027",
            "country_code": "US",
            "telephone_number": "314-977-4864",
            "fax_number": "314-977-4876",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KATELYN",
        "middle_name": "GRAY",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-07",
        "last_updated": "2020-08-31",
        "certification_date": "2020-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MO",
            "license": "2011019213",
            "primary": false
        },
        {
            "code": "2084S0012X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Sleep Medicine",
            "state": "PA",
            "license": "OS019215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ksmith166591@direct.geisinger.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "132 Abigail Ln",
            "city": "Port Matilda",
            "state": "PA",
            "country_code": "US",
            "postal_code": "168707153",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Port Matilda, PA

Sources for this page

Verify at the official NPI Registry.