Individual provider Active NPI

Roslyn M Hodge-Smith

  • Licensed Practical Nurse
  • Watertown, NY
National Provider Identifier
1407176316
Registry record updated Jun 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
288268-1 Issued in NY
Practice address
21107 Coffeen St
Watertown, NY 13601
Phone
(315) 782-9285
NPI assigned
Jun 3, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 288268-1 NY Primary

Addresses

Primary practice location

21107 Coffeen St
Watertown, NY 13601

Mailing address

25140 William St
Calcium, NY 13616-2177
Phone (315) 629-6798

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
288268-1NYMDLicensed Practical Nurse

NPI Registry JSON

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

{
    "created_epoch": "1275523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1275523200000",
    "number": "1407176316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25140 WILLIAM ST",
            "city": "CALCIUM",
            "state": "NY",
            "postal_code": "136162177",
            "telephone_number": "315-629-6798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21107 COFFEEN ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "13601",
            "telephone_number": "315-782-9285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HODGE-SMITH",
        "first_name": "ROSLYN",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-03",
        "last_updated": "2010-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "288268-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.