J S Michael Smith MD PA
Organization Active NPI Family Medicine Physician · Jay, FL
NPI 1497014161 · NPPES record last updated Oct 26, 2012
Key facts
- NPI
- 1497014161
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- ME89102 (FL)
- Legal business name
- J S MICHAEL SMITH MD PA
- Practice address
- 14088 Alabama St
Jay, FL 32565-1036 - Phone
- (850) 675-4546
- Fax
- (850) 675-4548
- NPI assigned
- May 15, 2012
- Organization subpart
- No
Authorized official
- Name
- John Stewart Michael Smith, MD
- Title
- Owner/President
- Phone
- (850) 675-4546
Practitioners 6
-
Mark James Elder, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20121026000158 | FL | Part B Supplier - Clinic/Group Practice | 2567612666 |
Receives reassigned benefits from 1 practitioner Practice locations: Jay, FL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | ME89102 | FL | Yes |
Addresses
Primary practice location
14088 Alabama St
Jay, FL 32565-1036
Mailing address
PO Box 10
Jay, FL 32565-0010
Phone (850) 675-4546
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 751241 | Other | COVENTRY | |
| 2553182 | Other | UNITED HEALTHCARE | |
| 592200521 | Other | CHAMPVA | |
| W560 | Other | WELLCARE | |
| 59180291 | Other | BLUE CROSS AND BLUE SHIELD OF ALABAMA | |
| 7839652 | Other | AETNA | |
| P00368813 | Other | RAILROAD MEDICARE | |
| 272533900 | Medicaid | FL | |
| 592200521 | Other | TRICARE | |
| 592200521 | Other | HUMANA | |
| 009996365 | Other | AL | ALACAID |
| 01512 | Other | BLUE CROSS AND BLUE SHIELD OF FLORIDA | |
| 2357174 | Other | CIGNA |
Other names
- John Stewart Michael Smith MD
Other providers in Jay, FL
- Gregory D Heaton OD PA
- Hayden Hammond
- Gregory D Heaton
- Rhonda L Heflin
- Jennifer M Holland
- Jay Hospital, Inc.
- Jay Hospital, Inc.
- Jay Hospital, Inc.
- Jay Pediatrics PA
- Jay Pharmacy of Jay Florida Inc
All providers in Jay, FL · Family Medicine Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 26, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.