Individual provider Active NPI

Michael Smith, RN

  • Certified Registered Nurse Anesthetist
  • Edgewood, KY
National Provider Identifier
1487630091
Registry record updated Sep 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
037860 Issued in KY
Practice address
20 Medical Village Dr
Suite 258
Edgewood, KY 41017
Phone
(859) 301-2211
NPI assigned
Dec 16, 2005
Last updated
Sep 29, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 037860 KY Primary
Registered Nurse 163W00000X 1054975 KY

Addresses

Primary practice location

20 Medical Village Dr
Suite 258
Edgewood, KY 41017

Mailing address

5363 Shadow Hill CT
Taylor Mill, KY 41015
Phone (859) 581-7952

Other identifiers 3

IdentifierTypeStateIssuer
74097817MedicaidKY
2166454MedicaidOH
000000389807OtherANTHEM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200928002775 IN Practitioner - Certified Registered Nurse Anesthetist (Crna) 1355390865 Reassigns benefits to 1 organization
I20210521001056 OH Practitioner - Certified Registered Nurse Anesthetist (Crna) 1355390865 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Outpatient Anesthesia SpecialistsGroup PAC ID 1456431162, 5 clinicians

Practice addresses (Care Compare)

2000 Joseph E Sanker Blvd
Cincinnati, OH 45212-1979
Phone (513) 841-7600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse, Registered Nurse

State licenses

LicenseStateTypeSpecialty
1054975KYMDRegistered Nurse
037860KYMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Deaconess Hospital, Inc Current Accepting new patients
Deaconess Hospital Inc CurrentSince Sep 28, 2020 Accepting new patients
Deaconess Hospital, Inc Nurse Anesthetist, Certified Registered CurrentSince Sep 28, 2020 Accepting new patients
Anesthesiology Services Network LTD CurrentSince Apr 15, 2021 Accepting new patients
Outpatient Anesthesia Specialists CurrentSince Aug 10, 2021 Accepting new patients
Christian Co Anesthesia Past Accepting new patients
Riverhills Anesthesia Associates Past Accepting new patients
Christian County Anesthesia, PLLC Past Accepting new patients
St. Luke Hospitals Inc Past Accepting new patients

Locations

600 Mary St
Evansville, IN 47710
Phone (812) 450-2239

4011 Gateway Blvd
Newburgh, IN 47630
Phone (812) 450-2240

1 Wyoming St
Dayton, OH 45409
Phone (937) 208-2636

2000 Joseph E Sanker Blvd
Norwood, OH 45212
Phone (513) 841-7400

4700 Smith Rd
Norwood, OH 45212
Phone (513) 366-3400

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1134691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790640000000",
    "number": "1487630091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5363 SHADOW HILL CT",
            "city": "TAYLOR MILL",
            "state": "KY",
            "postal_code": "41015",
            "telephone_number": "859-581-7952",
            "fax_number": "859-581-7952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 MEDICAL VILLAGE DR",
            "address_2": "SUITE 258",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "41017",
            "telephone_number": "859-301-2211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MICHAEL",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-16",
        "last_updated": "2026-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "037860",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "KY",
            "license": "1054975",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "74097817",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2166454",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000389807",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edgewood, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2026; 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.