Susan Lynn Smith, M.B.A., R.D.

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

722149

Practice address

3651 Kakela Makai Drive
Kalaheo, HI 96741-0411

Phone

(808) 212-4657

NPI assigned

Mar 2, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Telemedicine Group PCGroup PAC ID 9830351824, 94 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Business Administration

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: telemed2u.susansmith@160918.advancedmd-direct.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.

• Telehealth Specialty Medical Group

  • Emergency Medicine Physician
  • Roseville, CA
  • NPI 1326338237
  Medicare reassignment Care Compare group NPD
• Nourish, Inc.

  • Registered Dietitian
  • Austin, TX
  • NPI 1558097824

  Dietitian, Registered

  NPD (past)
• Tele-Medicine Services Ny, PLLC

  • Internal Medicine Physician
  • Roseville, CA
  • NPI 1609663780
  NPD (past)

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

{
    "created_epoch": "1299024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299024000000",
    "number": "1386942241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 411",
            "city": "KALAHEO",
            "state": "HI",
            "postal_code": "967410411",
            "telephone_number": "808-212-4657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3651 KAKELA MAKAI DRIVE",
            "city": "KALAHEO",
            "state": "HI",
            "postal_code": "967410411",
            "telephone_number": "808-212-4657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "SUSAN",
        "middle_name": "LYNN",
        "credential": "M.B.A., R.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-03-02",
        "last_updated": "2011-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": "722149",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CREDENTIALING AGENCY OF THE AMERICAN DIETETIC ASSOCIATION",
            "identifier": "722149",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Scott S. Shimabukuro, DDS
• Kalena Soltren Serraon, LCSW
• Shimabukuro Dental LLC
• Scott S Shimabukuro, DDS
• Shea Scott Shimabukuro, DDS
• Julia Solomon, RD
• Siobhan M Solomon
• Jeshua Spadino, DPT
• Warren B Sparks, MD
• Julianne G Spicer, MS CCC-SLP

• Registered Dietitian in Kalaheo, HI
• Providers in Kalaheo, HI by specialty
• Registered Dietitian in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.