Nicole Johnson-Smith

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

39003603A Issued in IN

Practice address

2155 N State Road 9
Lagrange, IN 46761-8746

Phone

(260) 463-7144

NPI assigned

Aug 16, 2019

Last updated

Aug 16, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2016

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Ywca Northeast Indiana Inc

  • Substance Abuse Rehabilitation Facility
  • Fort Wayne, IN
  • NPI 1629533658

  Mental Health

  Medicare reassignment NPD
• Northeastern Center Inc

  dba Northeastern Center

  • Community/Behavioral Health Agency
  • Kendallville, IN
  • NPI 1720140908
  NPD
• Bowen Health Inc

  • Federally Qualified Health Center (FQHC)
  • Fort Wayne, IN
  • NPI 1023668183
  NPD (past)
• Northeastern Center, Inc

  dba Northeastern Center Inpatient

  • Psychiatric Hospital
  • Auburn, IN
  • NPI 1689781346
  NPD (past)

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

{
    "created_epoch": "1565913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565913600000",
    "number": "1548816374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 191",
            "city": "LAGRANGE",
            "state": "IN",
            "postal_code": "467610191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2155 N STATE ROAD 9",
            "city": "LAGRANGE",
            "state": "IN",
            "postal_code": "467618746",
            "telephone_number": "260-463-7144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON-SMITH",
        "first_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-16",
        "last_updated": "2019-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "39003603A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard B Hostetter, M.D.
• Hasan Ilyas, MD
• Krista Jackson, PA
• Timothy A Jessie, MD
• Johnson Memorial Hospital (The Waters of LaGrange Skilled Nursing Facility)
• McKenna Lorraine Juday, FNP
• Vijay G.T. Kamineni, M.D.
• Rebecca L Kaminski, D.O.
• Shashank Nmi Kashyap, M.D.
• Shilpa Kashyap, MD

• Mental Health Counselor in Lagrange, IN
• Providers in Lagrange, IN by specialty
• Mental Health Counselor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2019; 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.

Verify at the official NPI Registry.