NPIMap

Individual provider Active NPI

Kenneth Ronald Smith, MD

  • Orthopaedic Surgery Physician
  • Bolivar, MO
National Provider Identifier
1508979477
Registry record updated Dec 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
MDR3K38 Issued in MO
Practice address
1155 W Parkview St
Suite 2D
Bolivar, MO 65613-8279
Phone
(417) 777-2663
Fax
(417) 777-2666
NPI assigned
Aug 16, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
University of Kansas School of Med (KC/Wich/Sal), 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Citizens Memorial Healthcare 144 clinicians

Practice addresses (Care Compare)

Bolivar, MO 65613
Phone (417) 328-6631

1155 W Parkview
Bolivar, MO 65613-7800

1155 W Parkview St
Bolivar, MO 65613-7800

1500 N Oakland Ave
CMH Diabetes
Bolivar, MO 65613-3099
Phone (417) 328-6040

Hospital & facility affiliations

  • Citizens Memorial Hospital Hospital, Bolivar, MO, CCN 260195

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100428000942 MO Practitioner - Orthopedic Surgery 4082741749 Reassigns benefits to 1 organization

All facility ownership & control disclosures 5

Medicare enrollment files

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Colonial Springs Healthcare CenterBuffalo, MO, CCN 265245 Skilled nursing facility Operational/Managerial Control
Managing Control - Governing Body
Adp of the SNF		 Mar 30, 2023
Mar 30, 2023
Mar 30, 2023
Parkview Health Care FacilityBolivar, MO, CCN 265519 Skilled nursing facility Operational/Managerial Control
Managing Control - Governing Body
Adp of the SNF		 Mar 30, 2023
Mar 30, 2023
Mar 30, 2023
Community Springs Healthcare FacilityEl Dorado Springs, MO, CCN 265446 Skilled nursing facility Operational/Managerial Control
Managing Control - Governing Body
Adp of the SNF		 Mar 30, 2023
Mar 30, 2023
Mar 30, 2023
Citizens Memorial Home HealthBolivar, MO, CCN 267196 Home health agency Corporate Director Jan 30, 2020
Citizens Memorial HospiceBolivar, MO, CCN 261508 Hospice Corporate Director Jan 1, 2024

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MDR3K38MOMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Citizens Memorial Healthcare CurrentSince Jun 1, 2003 Accepting new patients
Citizens Memorial Healthcare Orthopaedic Surgery CurrentSince Jun 1, 2003 Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

1245 N Butterfield Rd
Bolivar, MO 65613
Phone (417) 326-6000

1155 W Parkview St
Ste 2D
Bolivar, MO 65613
Phone (417) 777-2663

1500 N Oakland Ave
Bolivar, MO 65613
Phone (417) 326-6000

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X MDR3K38 MO Primary

Addresses

NPPES NPI Registry

Primary practice location

1155 W Parkview St
Suite 2D
Bolivar, MO 65613-8279

Mailing address

1500 N Oakland Ave
Bolivar, MO 65613-3011
Phone (417) 326-6000

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 10, 2015.

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449705600000",
    "number": "1508979477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 N OAKLAND AVE",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656133011",
            "telephone_number": "417-326-6000",
            "fax_number": "417-328-6338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 W PARKVIEW ST",
            "address_2": "SUITE 2D",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656138279",
            "telephone_number": "417-777-2663",
            "fax_number": "417-777-2666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KENNETH",
        "middle_name": "RONALD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-16",
        "last_updated": "2015-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MO",
            "license": "MDR3K38",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bolivar, MO

Sources for this page

Verify at the official NPI Registry.