Individual provider Active NPI

Jeffrey James Smidt, D.C.

  • Chiropractor
  • Bloomington, MN
National Provider Identifier
1487749784
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4152 Issued in MN
Practice address
9740 Irving Ave S
Bloomington, MN 55431-2625
Phone
(952) 224-5717
NPI assigned
Oct 3, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 4152 MN Primary

Addresses

Primary practice location

9740 Irving Ave S
Bloomington, MN 55431-2625

Mailing address

9740 Irving Ave S
Bloomington, MN 55431-2625
Phone (952) 224-5717

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060104000043 MN Practitioner - Chiropractic 4183646250 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

9740 Irving Ave S
Bloomington, MN 55431-2625
Phone (952) 994-0988

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4152MNMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Chirozone P.a. Chiropractor CurrentSince Nov 14, 2005 Accepting new patients
Chirocenter-Bloomington PA Chiropractor PastSince May 1, 2010 Accepting new patients

Locations

9740 Irving Ave S
Minneapolis, MN 55431
Phone (952) 224-5717

Organizations & group practices 2

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": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487749784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9740 IRVING AVE S",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554312625",
            "telephone_number": "952-224-5717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9740 IRVING AVE S",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554312625",
            "telephone_number": "952-224-5717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMIDT",
        "first_name": "JEFFREY",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "4152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.