Individual provider Active NPI

Phoebe L Smith, M.D.

  • Family Medicine Physician
  • Sebastopol, CA
National Provider Identifier
1396241147
Registry record updated Nov 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A164367 Issued in CA
Practice address
652 Petaluma Ave Ste H
Sebastopol, CA 95472-4266
Phone
(707) 823-3166
Fax
(707) 869-8170
NPI assigned
Apr 2, 2018
Last updated
Nov 15, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A164367 CA Primary

Addresses

Primary practice location

652 Petaluma Ave Ste H
Sebastopol, CA 95472-4266

Mailing address

652 Petaluma Ave Ste H
Sebastopol, CA 95472-4266
Phone (520) 437-9346

Other practice location 1

450 E Spring St Ste 1
Long Beach, CA 90806-1625
Phone (562) 933-0050

Other identifiers 1

IdentifierTypeStateIssuer
A164367OtherCATHE MEDICAL BOARD OF CALIFORNIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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

Enrollment IDStateProvider typePAC IDDetails
I20250516002212 MN Practitioner - Family Practice 7113352253 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fairview ClinicsGroup PAC ID 7113830142, 799 clinicians

Practice addresses (Care Compare)

2020 E 28TH St
Minneapolis, MN 55407-1394
Phone (612) 333-0770

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A164367CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Current Accepting new patients
Fairview Clinics CurrentSince May 30, 2025 Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Clinics CurrentSince May 30, 2025 Accepting new patients
Fairview Health Services CurrentSince May 30, 2025 Accepting new patients
Fairview Health Services CurrentSince May 30, 2025 Accepting new patients
Fairview Clinics Past Accepting new patients

Locations

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

2020 E 28th St
Minneapolis, MN 55407
Phone (612) 333-0770

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

500 Harvard St SE
Minneapolis, MN 55455
Phone (612) 273-7300

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

1700 University Ave W
Saint Paul, MN 55104
Phone (612) 672-6740

Interoperability endpoints

  • Direct secure messaging: psmith2675387@fairview.direct-ci.com

Organizations & group practices 8

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1522627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668470400000",
    "number": "1396241147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "652 PETALUMA AVE STE H",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954724266",
            "telephone_number": "520-437-9346",
            "fax_number": "707-869-8170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "652 PETALUMA AVE STE H",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954724266",
            "telephone_number": "707-823-3166",
            "fax_number": "707-869-8170"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "450 E Spring St Ste 1",
            "address_purpose": "LOCATION",
            "city": "Long Beach",
            "state": "CA",
            "postal_code": "908061625",
            "country_code": "US",
            "telephone_number": "562-933-0050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "PHOEBE",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-02",
        "last_updated": "2022-11-15",
        "certification_date": "2022-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A164367",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "THE MEDICAL BOARD OF CALIFORNIA",
            "identifier": "A164367",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sebastopol, CA

Sources for this page

Verify at the official NPI Registry.