Kenneth L Smith, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

048722 Issued in GA

Practice address

1831 5TH Ave
Columbus, GA 31904-8915

Phone

(706) 320-8660

Fax

(706) 320-8664

NPI assigned

Feb 7, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 12

Medicare fee-for-service enrollment

Enrolled in GA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Columbus Ambulatory Healthcare Services, Inc.

  • Family Medicine Physician
  • Columbus, GA
  • NPI 1790733244
  Medicare reassignment NPD
• Columbus Ambulatory Healthcare Services, Inc.

  • Family Medicine Physician
  • Phenix City, AL
  • NPI 1699240531
  NPD

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390176000000",
    "number": "1457323909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1038",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319021038",
            "telephone_number": "706-660-6148",
            "fax_number": "706-660-2843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1831 5TH AVE",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319048915",
            "telephone_number": "706-320-8660",
            "fax_number": "706-320-8664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KENNETH",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-07",
        "last_updated": "2014-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": "048722",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID-OFFICE",
            "identifier": "000879029B",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID-MMC",
            "identifier": "154859",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "20046782",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID-MMC",
            "identifier": "000879029D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009931860",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "52262489-003",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "52262489-005",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "600-11156",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID-DSH",
            "identifier": "000879029C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000879029A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID-NSMC",
            "identifier": "000879029E",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "600-96706",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Lacey Smith, MD
• Jennifer Nicole Smith
• Jillian Elizabeth Smith
• Keiundra Nichole Smith
• Kelvin Smith
• Kenyetta Smith, BCBA
• Kimberly Madison Smith, RBT
• Lakeasha Rebecca Smith
• Laquesha Smith, MS, BCBA
• Latasha Smith

• Surgery Physician in Columbus, GA
• Providers in Columbus, GA by specialty
• Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.