Kim Annette Smith, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

C4337 Issued in OR

Practice address

150 NE Kenneth Ford Dr
Roseburg, OR 97470-1042

Phone

(541) 672-9596

Fax

(541) 672-7146

NPI assigned

Apr 23, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kim A Oxford Former name

Medicare fee-for-service enrollment

Enrolled in OR

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kim.smith.1@17792.direct.athenahealth.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.

• Umpqua Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Roseburg, OR
  • NPI 1396751772
  Medicare reassignment NPD
• Umpqua Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Glide, OR
  • NPI 1609065010
  NPD
• Umpqua Community Health Center, Inc.

  dba Aviva Health

  • Federally Qualified Health Center (FQHC)
  • Roseburg, OR
  • NPI 1720803810
  NPD

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

{
    "created_epoch": "1429747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539043200000",
    "number": "1396132775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 NE KENNETH FORD DR",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974701042",
            "telephone_number": "541-672-9596",
            "fax_number": "541-440-3554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 NE KENNETH FORD DR",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974701042",
            "telephone_number": "541-672-9596",
            "fax_number": "541-672-7146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KIM",
        "middle_name": "ANNETTE",
        "name_prefix": "Mrs.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-23",
        "last_updated": "2018-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "C4337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIM",
            "last_name": "OXFORD",
            "middle_name": "A",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• David Marc Smith, MD
• Donice Smith
• Dustin Rae Smith, RN
• Jennifer Jade Smith, RPA
• Jeremy Michael Smith
• Kim D Smith
• Laura C Smith, PA
• Lowell F Smith, FNP
• Misty Smith, PHARMD
• Roberta Smith, RN

• Professional Counselor in Roseburg, OR
• Providers in Roseburg, OR by specialty
• Professional Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2018; 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.