Individual provider Active NPI

Renee Ingeborg Smilde, M.D.

  • Internal Medicine Physician
  • San Diego, CA
National Provider Identifier
1427010594
Registry record updated Mar 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A70175 Issued in CA
Practice address
4077 Fifth Ave
San Diego, CA 92103-2105
Phone
(619) 294-8111
NPI assigned
Apr 4, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 26, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A70175 CA Primary

Addresses

Primary practice location

4077 Fifth Ave
San Diego, CA 92103-2105

Mailing address

PO Box 87729
San Diego, CA 92138-7729
Phone (619) 285-5990

Other practice location 1

4094 4th Ave
San Diego, CA 92103-2143
Phone (619) 515-2545

Other identifiers 1

IdentifierTypeStateIssuer
00A701750MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20041215001073 CA Practitioner - Internal MedicinePractitioner - Hospice/Palliative Care 4587621032 Reassigns benefits to 4 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A70175CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Scripps Health Current Accepting new patients
Scripps Health Inpatient Providers Medical Group Inc. CurrentSince Aug 1, 2012 Accepting new patients
Family Health Centers of San Diego, Inc. CurrentSince Feb 27, 2019 Accepting new patients
Scripps Health Current Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Feb 27, 2019 Accepting new patients
Emergency and Acute Care Medical Corporation CurrentSince Sep 5, 2010 Accepting new patients
Family Health Centers of San Diego, Inc Current Accepting new patients
Family Health Centers of San Diego Inc Current Accepting new patients
Enlightened Healthcare Alliance Medical Corporation Internal Medicine CurrentSince Mar 22, 2020 Accepting new patients
Family Health Centers of San Diego Inc Current Accepting new patients
Scripps Health Past Accepting new patients
Premier Surgical Partners Inc Past Accepting new patients

Locations

435 H St
Chula Vista, CA 91910
Phone (619) 691-7000

662 Encinitas Blvd
Ste 204
Encinitas, CA 92024
Phone (760) 203-5545

9888 Genesee Ave
La Jolla, CA 92037
Phone (858) 457-4123

823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323

4094 4th Ave
San Diego, CA 92103
Phone (619) 515-2545

4077 5th Ave
San Diego, CA 92103
Phone (619) 260-7245

4275 Campus Point Ct
Ste 207
San Diego, CA 92121

7901 Frost St
San Diego, CA 92123
Phone (619) 541-3400

Interoperability endpoints

  • Direct secure messaging: rsmilde7983@scrippshlth.medalliesdirect.net

Organizations & group practices 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616716800000",
    "number": "1427010594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 87729",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921387729",
            "telephone_number": "619-285-5990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4077 FIFTH AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921032105",
            "telephone_number": "619-294-8111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4094 4th Ave",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921032143",
            "country_code": "US",
            "telephone_number": "619-515-2545",
            "fax_number": "619-501-9645",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMILDE",
        "first_name": "RENEE",
        "middle_name": "INGEBORG",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-04",
        "last_updated": "2021-03-26",
        "certification_date": "2021-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A70175",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A701750",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.