Kirkwood Medical Practice

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

KIRKWOOD MEDICAL PRACTICE

Practice address

865 Route 11
Kirkwood, NY 13795

Phone

(434) 420-0466

NPI assigned

Aug 29, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Jemille Smith, MDNPI 1457550071

Title

Owner

Phone

(434) 420-0466

Specialties & licenses 1

Addresses

Other names 1

• Jemille SMith Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jemille Smith, MD

  • General Practice Physician
  • Bronx, NY
  • NPI 1457550071
  Medicare reassignment Care Compare group Authorized official
• Bilqees B Abdallah, FNP

  • Family Nurse Practitioner
  • Hancock, NY
  • NPI 1336440130
  Medicare reassignment Care Compare group
• Nasir Abdul-Wadud, PA

  • Surgical Physician Assistant
  • Syracuse, NY
  • NPI 1033357371
  Medicare reassignment

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

{
    "created_epoch": "1693267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693267200000",
    "number": "1497530463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "865 ROUTE 11",
            "city": "KIRKWOOD",
            "state": "NY",
            "postal_code": "13795",
            "telephone_number": "434-420-0466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "865 ROUTE 11",
            "city": "KIRKWOOD",
            "state": "NY",
            "postal_code": "13795",
            "telephone_number": "434-420-0466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIRKWOOD MEDICAL PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-29",
        "last_updated": "2023-08-29",
        "certification_date": "2023-08-26",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "JEMILLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "434-420-0466",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jemille SMith",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amy M Ivan, L.P.T.A.
• Sandra Juriga, PH.D.
• K. Hope Mental Health Counseling Services P.L.L.C.
• Audrey Kase
• Kara Kenderish, PSY.D.
• Sarah Klotz
• Robyn Lawrence
• Junior Louis
• Cadence Lusk, LPN
• Rachel Marie Macblane, LPN

• Clinic/Center in Kirkwood, NY
• Providers in Kirkwood, NY by specialty
• Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.