Individual provider Active NPI

Katelyn Devonne Smith, DO

  • Family Medicine Physician
  • Highland Heights, KY
National Provider Identifier
1538737671
Registry record updated Jul 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
05676 Issued in KY
Practice address
2626 Alexandria Pike
Highland Heights, KY 41076-1530
Phone
(859) 781-4111
NPI assigned
Jun 15, 2021
Last updated
Jul 10, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 05676 KY Primary

Addresses

Primary practice location

2626 Alexandria Pike
Highland Heights, KY 41076-1530

Mailing address

413 S Loop Rd
Edgewood, KY 41017-5446
Phone (859) 301-3800

Other practice location 1

413 S Loop Rd
Edgewood, KY 41017-5446
Phone (859) 301-3800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20240917001275 KY Practitioner - Family Practice 1153862263 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Pikeville, Kentucky College of Osteopathic Med, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Medical Group IncGroup PAC ID 2163326240, 803 clinicians

Practice addresses (Care Compare)

2626 Alexandria Pike
Highland Heights, KY 41076-1530
Phone (859) 757-0434

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Medical Group, Inc. CurrentSince Jul 29, 2024 Accepting new patients
Summit Medical Group, Inc Family Medicine CurrentSince Jul 29, 2024 Accepting new patients
St Elizabeth Medical Center, Inc Past Accepting new patients

Locations

405 Violet Rd
Crittenden, KY 41030
Phone (859) 428-1610

1980 Litton Ln
Hebron, KY 41048
Phone (859) 334-8700

2626 Alexandria Pike
Highland Heights, KY 41076
Phone (859) 757-0434

1400 Grand Ave
Newport, KY 41071
Phone (859) 905-3070

300 Barnes Rd
Williamstown, KY 41097
Phone (859) 824-8217

Interoperability endpoints

  • Direct secure messaging: katelyn.smith.1@24668.direct.athenahealth.com
  • Direct secure messaging: ksmith351775@direct-prd.stelizabeth.com

Organizations & group practices 3

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1623715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720569600000",
    "number": "1538737671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 S LOOP RD",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410175446",
            "telephone_number": "859-301-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2626 ALEXANDRIA PIKE",
            "city": "HIGHLAND HEIGHTS",
            "state": "KY",
            "postal_code": "410761530",
            "telephone_number": "859-781-4111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "413 S Loop Rd",
            "address_purpose": "LOCATION",
            "city": "Edgewood",
            "state": "KY",
            "postal_code": "410175446",
            "country_code": "US",
            "telephone_number": "859-301-3800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KATELYN",
        "middle_name": "DEVONNE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-15",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "05676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Highland Heights, KY

Sources for this page

Verify at the official NPI Registry.