Smithcare: General Dermatology, Mohs Surgery & Aesthetics PLLC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

Legal business name

SMITHCARE: GENERAL DERMATOLOGY, MOHS SURGERY & AESTHETICS PLLC

Doing business as

Smithcare: Dermatology

Practice address

21800 Market PL NW Ste 103
Poulsbo, WA 98370-6667

Phone

(360) 291-5700

Fax

(360) 291-5702

NPI assigned

Jul 29, 2021

Last updated

Sep 8, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Andrea Dawn Smith, MDNPI 1801064969

Title

Managing Member/Physician

Phone

(360) 291-5700

Specialties & licenses 4

Addresses

Other names 1

• SMITHCARE: DERMATOLOGY Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Andrea Dawn Smith, MD

  • Dermatology Physician
  • Poulsbo, WA
  • NPI 1801064969
  Medicare reassignment Care Compare group NPD Authorized official
• Katie Lynn Ernst, APRN, DNP

  • Family Nurse Practitioner
  • Poulsbo, WA
  • NPI 1851811327

  Dermatology

  Medicare reassignment Care Compare group NPD
• Jeffrey Wayne Gertner, MD

  • Dermatology Physician
  • Poulsbo, WA
  • NPI 1912980624
  Medicare reassignment Care Compare group NPD
• Ginger Bouma, MD

  • Physician Assistant
  • Poulsbo, WA
  • NPI 1679507289
  Medicare reassignment Care Compare group
• Alison M Stinnett, PA

  • Physician Assistant
  • Poulsbo, WA
  • NPI 1427066323
  Medicare reassignment

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

{
    "created_epoch": "1627516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631059200000",
    "number": "1417620998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21800 MARKET PL NW STE 103",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983706667",
            "telephone_number": "360-291-5700",
            "fax_number": "360-291-5702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21800 MARKET PL NW STE 103",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983706667",
            "telephone_number": "360-291-5700",
            "fax_number": "360-291-5702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMITHCARE: GENERAL DERMATOLOGY, MOHS SURGERY & AESTHETICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-29",
        "last_updated": "2021-09-08",
        "certification_date": "2021-09-08",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "MANAGING MEMBER/PHYSICIAN",
        "authorized_official_telephone_number": "360-291-5700",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SMITHCARE: DERMATOLOGY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SMITHCARE: DERMATOLOGY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Smartspeidel LLC (Natural Health Clinic)
• Andrea Dawn Smith, MD
• Kalene Elizabeth Smith, DH
• Le' Roy Smith Jr., CDPT
• Lisa Jeanette Smith, LICSW
• Sound Family Medicine and Urgent Care PLLC (Sound Family Health)
• Sound Health and Wellness Center Inc.
• Sound Oxygen Service LLC (AdaptHealth)
• Sound Pediatrics, PLLC
• Stephen Douglas Speidel, N.D.

• MOHS-Micrographic Surgery Physician in Poulsbo, WA
• Providers in Poulsbo, WA by specialty
• MOHS-Micrographic Surgery Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2021; 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.