Christopher Shane Smith, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9102127 Issued in FL

Practice address

5147 N 9TH Ave Ste 311
Pensacola, FL 32504-8770

Phone

(850) 477-2597

Fax

(850) 478-7941

NPI assigned

Oct 5, 2006

Last updated

Mar 27, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• C Shane Smith Professional name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Gastroenterology Associates of Pensacola PA

  • Gastroenterology Physician
  • Pensacola, FL
  • NPI 1235223785
  Medicare reassignment
• Gastroenterology Associates of Pensacola PA

  • Anatomic Pathology & Clinical Pathology Physician
  • Pensacola, FL
  • NPI 1861535403
  NPD

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522108800000",
    "number": "1538255476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4828 N DAVIS HWY",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325032341",
            "telephone_number": "850-477-8109",
            "fax_number": "850-478-2412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5147 N 9TH AVE STE 311",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325048770",
            "telephone_number": "850-477-2597",
            "fax_number": "850-478-7941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "CHRISTOPHER",
        "middle_name": "SHANE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2018-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9102127",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "970030058",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009913575",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291473500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF ALABAMA",
            "identifier": "059076677",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "C",
            "last_name": "SMITH",
            "middle_name": "SHANE",
            "credential": "PA-C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Brooke Smith, RBT
• Carissa A Smith, LCSW
• Cayden Smith
• Chad Smith, CRNA
• Christina L Smith, CRNA
• David Michael Smith III, DO
• David R Smith, MD
• Dena J Smith, DO
• Emily Smith, PT
• Erin Elizabeth Smith, MD

• Physician Assistant in Pensacola, FL
• Providers in Pensacola, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.