Kelly Elizabeth Smith, LCSW, CSAC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904010148 Issued in VA

Practice address

216 Gilmer Street
Lebanon, VA 24266

Phone

(276) 889-3063

NPI assigned

Nov 27, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

35.98 of 100Reported as group

Quality

0

Promoting interoperability

0

Improvement activities

20

Cost

78.28

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Cumberland Mountain Community Services

  • Community/Behavioral Health Agency
  • Cedar Bluff, VA
  • NPI 1235125055
  NPD (past)

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

{
    "created_epoch": "1511740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511740800000",
    "number": "1568976751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 810",
            "city": "CEDAR BLUFF",
            "state": "VA",
            "postal_code": "246090810",
            "telephone_number": "276-964-6702",
            "fax_number": "276-964-0292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 GILMER STREET",
            "city": "LEBANON",
            "state": "VA",
            "postal_code": "24266",
            "telephone_number": "276-889-3063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KELLY",
        "middle_name": "ELIZABETH",
        "credential": "LCSW, CSAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-27",
        "last_updated": "2017-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "VA",
            "license": "0710103119",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904010148",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelli Sargent-White, COTA
• Amanda Cherie Sexton, LPC
• Cora Grace Shelton, FNP
• Lorin Elise Shortt, MA, CCC-SLP
• Tyler Skeen
• Samuel Smith, PT, DPT
• Southwest Regional Counseling Service Inc
• Vanessa Stacy
• Charles Seth Stanley, PT, DPT
• Steve Ball DDS PC

• Clinical Social Worker in Lebanon, VA
• Providers in Lebanon, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2017; 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.