Individual provider Active NPI

Blaine Daniel Smith, MD

  • Otolaryngology Physician
  • Jacksonville, FL
National Provider Identifier
1568996775
Registry record updated May 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
ME161800 Issued in FL
Practice address
1301 Palm Ave Ste 600
Jacksonville, FL 32207-8457
Phone
(904) 202-7300
Fax
(904) 202-2754
NPI assigned
Apr 13, 2017
Last updated
May 6, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 2022-01059 NC
Otolaryngology Physician 207Y00000X ME161800 FL Primary
Plastic Surgery within the Head & Neck (Otolaryngology) Physician 207YX0007X ME161800 FL

Addresses

Primary practice location

1301 Palm Ave Ste 600
Jacksonville, FL 32207-8457

Mailing address

PO Box 746654
Atlanta, GA 30374-6654
Phone (904) 202-2092

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bsmith836488@direct.UNC.nchie.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, FL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20220805000064 NC Practitioner - Otolaryngology 7416339544 Reassigns benefits to 1 organization
I20230718000031 FL Practitioner - OtolaryngologyPractitioner - Plastic and Reconstructive SurgeryPractitioner - Surgical Oncology 7416339544 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
OtolaryngologyAlso: Plastic and Reconstructive Surgery, Surgical Oncology
Education
University of Texas Medical School at Houston, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baptist MD Anderson Cancer Physicians IncGroup PAC ID 5991932063, 115 clinicians

Practice addresses (Care Compare)

1301 Palm Ave
Jacksonville, FL 32207-8432
Phone (904) 202-7300

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision40
Removal of tissue1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2022-01059NCMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist MD Anderson Cancer Physicians Inc Otolaryngology CurrentSince May 11, 2025 Accepting new patients
Baptist MD Anderson Cancer Physicians Inc Otolaryngology CurrentSince Aug 21, 2023 Accepting new patients
University of North Carolina at Chapel Hill Otolaryngology CurrentSince Jul 6, 2022 Accepting new patients

Locations

1301 Palm Ave
Jacksonville, FL 32207
Phone (844) 632-2278

1301 Palm Ave
Ste 600
Jacksonville, FL 32207

14546 Old Saint Augustine Rd
Ste 105
Jacksonville, FL 32258
Phone (904) 271-6890

101 Manning Dr
Chapel Hill, NC 27514
Phone (984) 974-1485

5221 Paramount Pkwy
Ste 420
Morrisville, NC 27560
Phone (984) 215-6533

Interoperability endpoints

  • Direct secure messaging: bsmith149884@baptisthealthsystemjacksonville.direct-ci.com
  • Direct secure messaging: bsmith836488@direct.unc.nchie.net

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": "1492041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746489600000",
    "number": "1568996775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746654",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746654",
            "telephone_number": "904-202-2092",
            "fax_number": "904-376-4075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 PALM AVE STE 600",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078457",
            "telephone_number": "904-202-7300",
            "fax_number": "904-202-2754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "BLAINE",
        "middle_name": "DANIEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-13",
        "last_updated": "2025-05-06",
        "certification_date": "2025-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NC",
            "license": "2022-01059",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "FL",
            "license": "ME161800",
            "primary": true
        },
        {
            "code": "207YX0007X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "FL",
            "license": "ME161800",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bsmith836488@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "101 Manning Dr",
            "city": "Chapel Hill",
            "state": "NC",
            "country_code": "US",
            "postal_code": "275144220",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.