NPIMap

Individual provider Active NPI

Andre' Blair Smith, MD

  • Family Medicine Physician
  • Lansing, MI
National Provider Identifier
1417920463
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301056626 Issued in MI
Practice address
4416 Blackberry LN
Lansing, MI 48917-1633
Phone
(517) 775-9799
Fax
(877) 488-5507
NPI assigned
Feb 9, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 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 4301056626 MI Primary

Addresses

Primary practice location

4416 Blackberry LN
Lansing, MI 48917-1633

Mailing address

4416 Blackberry LN
Lansing, MI 48917-1633
Phone (517) 775-9799

Other identifiers 2

IdentifierTypeStateIssuer
0330434OtherMIBCBS
4324357MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100601000639 MI Practitioner - Family Practice 6608905609 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Human Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Powerback Rehabilitation LLCGroup PAC ID 2365359932, shared by 106 NPIs, 600 clinicians

Practice addresses (Care Compare)

4416 Blackberry LN
Lansing, MI 48917-1633
Phone (517) 775-9799

4775 Village Dr
Grand Ledge, MI 48837-8107
Phone (517) 412-2240

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301056626MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sandrey Home Health Care PC Family Medicine CurrentSince Mar 23, 2016 Accepting new patients
At Home Doctors, PC Family Medicine CurrentSince Nov 15, 2011 Accepting new patients
Ingham Nephrology and Hypertension PC Past Accepting new patients

Locations

2843 E Grand River Ave
#260
East Lansing, MI 48823
Phone (517) 206-1388

2843 E Grand River Ave
Ste 260
East Lansing, MI 48823

124 N Grand Ave
Fowlerville, MI 48836
Phone (517) 223-3337

4136 Legacy Pkwy
Ste 100
Lansing, MI 48911
Phone (517) 708-2001

Organizations & group practices 3

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.

Hospital & facility affiliations 10

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": "1139443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1417920463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4416 BLACKBERRY LN",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489171633",
            "telephone_number": "517-775-9799",
            "fax_number": "877-488-5507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4416 BLACKBERRY LN",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489171633",
            "telephone_number": "517-775-9799",
            "fax_number": "877-488-5507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "ANDRE'",
        "middle_name": "BLAIR",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-09",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301056626",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0330434",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4324357",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lansing, MI

Sources for this page

Verify at the official NPI Registry.