Shane O Smith, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA08487 Issued in TX

Practice address

1104 Rayford Rd Ste 500
Spring, TX 77386-2621

Phone

(281) 825-3265

NPI assigned

Mar 2, 2010

Sex

Male

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 TX

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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 and National Provider Directory roles.

• Ucp Physicians of Central Texas, PLLC

  • Urgent Care Clinic/Center
  • Georgetown, TX
  • NPI 1922289412
  Medicare reassignment
• Ucp Physicians of Central Texas, PLLC

  • Urgent Care Clinic/Center
  • Austin, TX
  • NPI 1154472967
  NPD

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

{
    "created_epoch": "1267488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678752000000",
    "number": "1609199876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16840 BUCCANEER LN STE 202",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770582570",
            "telephone_number": "281-991-2200",
            "fax_number": "281-991-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 RAYFORD RD STE 500",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773862621",
            "telephone_number": "281-825-3265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "SHANE",
        "middle_name": "O",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-03-02",
        "last_updated": "2023-03-14",
        "certification_date": "2022-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA08487",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nathaniel Lewis Smith, LPC
• Priscilla Nicole Smith
• Raven M Smith, APRN, FNP-C
• Rebecka Smith, BCBA, LBA
• Samantha Smith
• Spencer J Smith, CPO, LOP
• Steven Scott Smith, DC
• Tamia Smith
• Tanya Smith, COTA
• Tatyanna C Smith, BT

• Physician Assistant in Spring, TX
• Providers in Spring, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.