Active NPI
Kevin A Smith, M.D.
- Family Medicine Physician
- Barstow, CA
National Provider Identifier
1386630895
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- CAG77804
- Practice address
- 525 Melissa Ave Ste a
Barstow, CA 92311-3002 - Phone
- (760) 255-2400
- Fax
- (760) 588-4990
- NPI assigned
- Sep 21, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | CAG77804 | CA | Primary |
Addresses
Primary practice location
525 Melissa Ave Ste a
Barstow, CA 92311-3002
Mailing address
PO Box 1946
Barstow, CA 92312-1946
Phone (760) 255-2400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G778041 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Howard University College of Medicine, 1990
- Medicare assignment
- May accept Medicare assignment
- Group practices
Practice addresses (Care Compare)
500 S 7TH Ave
Suite a
Barstow, CA 92311-3057
Phone (760) 255-2400
525 Melissa Ave
Suite a
Barstow, CA 92311-3002
525 Melissa Ave a
Barstow, CA 92311-3002
Hospital & facility affiliations
- Barstow Community Hospital
- Mercy Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 77804 | CA | MD | Pharmacist |
| CAG77804 | CA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hospital of Barstow Inc | Past | Accepting new patients | |
| High Desert Limb Salvage Institute Podiatrist Corp | Past | Accepting new patients |
Interoperability endpoints
- ksmith23@yourcarecommunity.org
Organizations & group practices 3
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.
-
- Primary Care Clinic/Center
- Barstow, CA
- NPI 1164567426
-
- Podiatric Clinic/Center
- Apple Valley, CA
- NPI 1588132062
-
- General Acute Care Hospital
- Barstow, CA
- NPI 1780655670
Hospital & facility affiliations 9
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Barstow, CA
- NPI 1780655670
-
- Addiction (Substance Use Disorder) Psychologist
- Fridley, MN
- NPI 1083197214
Hospital
-
- General Acute Care Hospital
- Cambridge, MN
- NPI 1215755400
-
- Substance Use Disorder Rehabilitation Hospital Unit
- Fridley, MN
- NPI 1285692145
-
- General Acute Care Hospital
- Coon Rapids, MN
- NPI 1316904287
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Fridley, MN
- NPI 1598700528
Hospital
-
- Psychiatric Hospital Unit
- Fridley, MN
- NPI 1609056100
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282608000000",
"number": "1386630895",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1946",
"city": "BARSTOW",
"state": "CA",
"postal_code": "923121946",
"telephone_number": "760-255-2400",
"fax_number": "760-588-4990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "525 MELISSA AVE STE A",
"city": "BARSTOW",
"state": "CA",
"postal_code": "923113002",
"telephone_number": "760-255-2400",
"fax_number": "760-588-4990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "KEVIN",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-09-21",
"last_updated": "2010-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "CAG77804",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G778041",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Barstow, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2010; 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.