Kelly Craghill Fagerburg Smith, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

473 Issued in ND

Practice address

1308 23Rd St S
Fargo, ND 58103-3707

Phone

(701) 297-7540

Fax

(701) 297-6439

NPI assigned

Oct 22, 2012

Last updated

Mar 11, 2015By 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ND

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northeast Human Service CenterGroup PAC ID 1658341441, 22 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Northeast Behavioral Health Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Grand Forks, ND
  • NPI 1366496341
  Medicare reassignment Care Compare group NPD
• Badlands Behavioral Health Clinic

  dba Badlands HSC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Dickinson, ND
  • NPI 1124072525
  Medicare reassignment NPD
• Benson Psychological Services PC

  • Community/Behavioral Health Agency
  • Fargo, ND
  • NPI 1477709574
  Medicare reassignment NPD
• Lake Region Behavioral Health Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Devils Lake, ND
  • NPI 1669411930
  Medicare reassignment NPD
• North Central Behavioral Health Clinic

  • Clinic/Center
  • Minot, ND
  • NPI 1477592533
  Medicare reassignment NPD
• Northwest Behavioral Health Clinic

  • Adult Mental Health Clinic/Center
  • Williston, ND
  • NPI 1770524613
  Medicare reassignment NPD
• South Central Behavioral Health Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Jamestown, ND
  • NPI 1225075906
  Medicare reassignment NPD
• Southeast Behavioral Health Clinic

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Fargo, ND
  • NPI 1932146941
  Medicare reassignment NPD
• West Central Behavioral Health Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bismarck, ND
  • NPI 1649226713
  Medicare reassignment NPD
• Northeast Human Service Center

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Grand Forks, ND
  • NPI 1891808978
  NPD
• Badlands Behavioral Health Clinic

  • Community/Behavioral Health Agency
  • Dickinson, ND
  • NPI 1952828360
  NPD (past)
• Benson Psychological Services, PC

  • Psychologist
  • Moorhead, MN
  • NPI 1437540929
  NPD (past)

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

{
    "created_epoch": "1350864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426032000000",
    "number": "1376896803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1308 23RD ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581033707",
            "telephone_number": "701-297-7540",
            "fax_number": "701-297-6439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1308 23RD ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581033707",
            "telephone_number": "701-297-7540",
            "fax_number": "701-297-6439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KELLY",
        "middle_name": "CRAGHILL FAGERBURG",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-22",
        "last_updated": "2015-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "ND",
            "license": "473",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "ND",
            "license": "473",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "17313",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julia Smith
• Kari Louise Smith, CRNA
• Karianne Smith, LSW
• Kathrine Ann Smith, LCSW
• Kathy Marie Smith, L.I.C.S.W
• Kimberly Joan Smith, M.S.
• Matthew Lynn Smith, RN, BSN, MS, CRNA
• Meghan Marie Smith, DDS
• Rylee Smith
• Sarah Fidele Smith

• Psychologist in Fargo, ND
• Providers in Fargo, ND by specialty
• Psychologist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.