Staceyann Smith, M.D., MPH

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

294338 Issued in NY

Practice address

3444 Kossuth Ave
Bronx, NY 10467-2410

Phone

(718) 920-5271

Fax

(718) 652-5707

NPI assigned

Jun 4, 2015

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

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H3359

Interoperability endpoints

• Direct secure messaging: stasmith@montefioredirect.com

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.

• Montefiore Medical Center

  • Anesthesiology Physician
  • Bronx, NY
  • NPI 1063525152

  Pediatrics

  Medicare reassignment NPD
• Montefiore Medical Center

  • Community/Retail Pharmacy
  • Bronx, NY
  • NPI 1194183715
  NPD
• Montefiore Medical Center

  • General Acute Care Hospital
  • Bronx, NY
  • NPI 1952476988
  NPD (past)

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

{
    "created_epoch": "1433376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563148800000",
    "number": "1386024370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3444 KOSSUTH AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672410",
            "telephone_number": "718-920-5271",
            "fax_number": "718-652-5707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3444 KOSSUTH AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672410",
            "telephone_number": "718-920-5271",
            "fax_number": "718-652-5707"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "160 E Erie Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191341011",
            "country_code": "US",
            "telephone_number": "215-427-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "STACEYANN",
        "credential": "M.D., MPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-04",
        "last_updated": "2019-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": "MT209229",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "294338",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shantelle Smith
• Shatasia Smith, LPN
• Sherelle Smith
• Simone Smith, MHC-LP
• Sophia Smith, LPN
• Tamara Smith, M.ED
• Tamara Smith
• Tanya Smith
• Tara Lea Smith
• Tarnisha Smith, LPN

• Pediatrics Physician in Bronx, NY
• Providers in Bronx, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.