Individual provider Active NPI

Cindy Ann Smith, D.O.

  • Family Medicine Physician
  • Moraine, OH
National Provider Identifier
1538169776
Registry record updated Feb 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
34.007138 Issued in OH
Practice address
3033 Kettering Blvd Ste 100
Moraine, OH 45439
Phone
(937) 293-2133
NPI assigned
Jul 29, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 34.007138 OH Primary

Addresses

Primary practice location

3033 Kettering Blvd Ste 100
Moraine, OH 45439

Mailing address

3033 Kettering Blvd Ste 100
Moraine, OH 45439-1948
Phone (937) 293-2133

Other practice location 1

2055 Stablehand Dr
Centerville, OH 45458-9743
Phone (937) 350-5708

Other practice location 2

2055 Stablehand Dr
Centerville, OH 45458-9743
Phone (937) 350-5708

Other identifiers 1

IdentifierTypeStateIssuer
2990189MedicaidOH

Other names 1

  • Cindy Ann Simon Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090924000488 OH Practitioner - Family Practice 6406872761 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34.007138OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Vpa PC Family Medicine Current Accepting new patients
Vpa PC Family Medicine CurrentSince Mar 1, 2019 Accepting new patients
Vpa PC Family Medicine Current Accepting new patients
Vpa PC Family Medicine CurrentSince Mar 1, 2019 Accepting new patients
Premier Family Medical Associates, P.C. Family Medicine PastSince Jul 1, 1998 Accepting new patients

Locations

500 Kirts Blvd
Ste 100
Troy, MI 48084
Phone (214) 824-6000

355 E Campus View Blvd
Ste 180
Columbus, OH 43235
Phone (614) 523-2155

3033 Kettering Blvd
Ste 100
Moraine, OH 45439
Phone (937) 293-2133

Organizations & group practices 5

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": "1122595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551052800000",
    "number": "1538169776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3033 KETTERING BLVD STE 100",
            "city": "MORAINE",
            "state": "OH",
            "postal_code": "454391948",
            "telephone_number": "937-293-2133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3033 KETTERING BLVD STE 100",
            "city": "MORAINE",
            "state": "OH",
            "postal_code": "45439",
            "telephone_number": "937-293-2133"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2055 Stablehand Dr",
            "address_purpose": "LOCATION",
            "city": "Centerville",
            "state": "OH",
            "postal_code": "454589743",
            "country_code": "US",
            "telephone_number": "937-350-5708",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2055 Stablehand Dr",
            "address_purpose": "LOCATION",
            "city": "Centerville",
            "state": "OH",
            "postal_code": "454589743",
            "country_code": "US",
            "telephone_number": "937-350-5708",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "CINDY",
        "middle_name": "ANN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-29",
        "last_updated": "2019-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "34.007138",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2990189",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CINDY",
            "last_name": "SIMON",
            "middle_name": "ANN",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Moraine, OH

Sources for this page

Verify at the official NPI Registry.