Active NPI
Jill J Smith, NP-C
- Nurse Practitioner
- Warren, MN
National Provider Identifier
1528588282
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 5209
- Practice address
- 300 W Good Samaritan Dr
Warren, MN 56762-1412 - Phone
- (218) 745-4211
- Fax
- (218) 745-3254
- NPI assigned
- Jun 23, 2017
- Last updated
- Nov 4, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 5209 | MN | Primary |
Addresses
Primary practice location
300 W Good Samaritan Dr
Warren, MN 56762-1412
Mailing address
300 W Good Samaritan Dr
Warren, MN 56762-1412
Phone (218) 745-4211
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jsmith7085@direct.directaltru.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- University of North Dakota School of Medicine, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
300 W Good Samaritan Dr
Warren, MN 56762-1412
Phone (218) 745-4211
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5209 | MN | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Warren Community Hospital, Inc. | Current | Accepting new patients | |
| Warren Community Hospital, Inc. | Past | Accepting new patients |
Locations
300 W Good Samaritan Dr
Warren, MN 56762
Phone (218) 745-4211
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba North Valley Health Center
- Critical Access Hospital
- Warren, MN
- NPI 1073516357
-
dba North Valley Health Center
- Rural Health Clinic/Center
- Warren, MN
- NPI 1972642213
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba North Valley Health Center
- Critical Access Hospital
- Warren, MN
- NPI 1073516357
-
- General Acute Care Hospital
- Grand Forks, ND
- NPI 1154346161
-
dba HIA Hospice
- Community Based Hospice Care Agency
- Fargo, ND
- NPI 1538253646
-
dba Good Samaritan Society - Home Care
- Home Health Agency
- Devils Lake, ND
- NPI 1841272226
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1635984000000",
"number": "1528588282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 W GOOD SAMARITAN DR",
"city": "WARREN",
"state": "MN",
"postal_code": "567621412",
"telephone_number": "218-745-4211",
"fax_number": "218-745-3254"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 W GOOD SAMARITAN DR",
"city": "WARREN",
"state": "MN",
"postal_code": "567621412",
"telephone_number": "218-745-4211",
"fax_number": "218-745-3254"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "JILL",
"middle_name": "J",
"credential": "NP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-23",
"last_updated": "2021-11-04",
"certification_date": "2021-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MN",
"license": "5209",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "jsmith7085@direct.directaltru.org",
"affiliation": "N",
"address_1": "300 W Good Samaritan Dr",
"city": "Warren",
"state": "MN",
"country_code": "US",
"postal_code": "567621412",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Warren, MN
- Midwest Regenerative Medicine Center PC
- North Star Manor
- Mark Alan Pederson, DC
- Paige Pederson
- Shane Skeim, FNP-C
- Nicole Rose Steien
- The Evangelical Lutheran Good Samaritan Society (Good Samaritan Society - Warren)
- Warren Community Hospital, Inc. (North Valley Health Center)
- Warren Community Hospital, Inc. (North Valley Public Health)
- Warren Community Hospital, Inc. (North Valley Health Center)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.