NPIMap

Individual provider Active NPI

Kelly Ann Smith, MD

  • Emergency Medicine Physician
  • Bend, OR
National Provider Identifier
1578791984
Registry record updated Sep 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
2012015996 Issued in MO
Practice address
2500 NE Neff Rd
Bend, OR 97701-6015
Phone
(541) 382-4321
NPI assigned
Jun 24, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 2012015996 MO Primary

Addresses

Primary practice location

2500 NE Neff Rd
Bend, OR 97701-6015

Mailing address

2500 NE Neff Rd
Bend, OR 97701-6015

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ksmith18233@secure.stcharleshealthcare.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150629003162 OR Practitioner - Critical Care (Intensivists)Practitioner - Emergency Medicine 7517196694 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)Also: Emergency Medicine
Education
Wayne State University School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Charles Health System IncGroup PAC ID 3870402852, 174 clinicians
Central Oregon Emergency Physicians LLCGroup PAC ID 6406926211, 30 clinicians

Practice addresses (Care Compare)

2500 NE Neff Rd
Bend, OR 97701-6015
Phone (541) 706-2768

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.08 of 100Reported as group
Quality
80.14
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2012015996MOMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Oregon Emergency Physicians LLC CurrentSince Mar 9, 2017 Accepting new patients
St. Charles Health System, Inc. Emergency Medicine CurrentSince Oct 1, 2024 Accepting new patients
St. Charles Health System, Inc. Emergency Medicine Current Accepting new patients
St. Charles Health System, Inc. Past Accepting new patients
St. Charles Health System, Inc. Emergency Medicine Past Accepting new patients
St. Charles Health System, Inc. Past Accepting new patients

Locations

29358 Network Pl
Chicago, IL 60673

2500 NE Neff Rd
Bend, OR 97701
Phone (541) 388-4333

211 NW Larch Ave
Redmond, OR 97756
Phone (541) 548-2164

1253 NW Canal Blvd
Redmond, OR 97756
Phone (541) 548-8131

Interoperability endpoints

  • Direct secure messaging: ksmith18233@secure.stcharleshealthcare.org

Organizations & group practices 6

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.

Hospital & facility affiliations 2

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": "1245801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727136000000",
    "number": "1578791984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 NE NEFF RD",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 NE NEFF RD",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016015",
            "telephone_number": "541-382-4321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-24",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MO",
            "license": "2012015996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ksmith18233@secure.stcharleshealthcare.org",
            "affiliation": "N",
            "address_1": "2500 NE Neff Rd",
            "city": "Bend",
            "state": "OR",
            "country_code": "US",
            "postal_code": "977016015",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

Verify at the official NPI Registry.