Stacie Renee Smith, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA-359 Issued in AR

Practice address

108 N Shackleford Rd
Little Rock, AR 72211-2840

Phone

(501) 712-2571

Fax

(501) 404-7789

NPI assigned

Sep 30, 2008

Last updated

Apr 5, 2022By 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 OR

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

Specialty

Physician Assistant

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Virginia Garcia Memorial Health CenterGroup PAC ID 7113823881, 87 clinicians

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Virginia Garcia Memorial Health Center

  • Federally Qualified Health Center (FQHC)
  • Cornelius, OR
  • NPI 1679528012
  Medicare reassignment Care Compare group NPD (past)
• Virginia Garcia Memorial Health Center

  • Federally Qualified Health Center (FQHC)
  • Hillsboro, OR
  • NPI 1457229197
  NPD
• Virginia Garcia Memorial Health Center

  • Federally Qualified Health Center (FQHC)
  • Hillsboro, OR
  • NPI 1891431557
  NPD

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

{
    "created_epoch": "1222732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649116800000",
    "number": "1619128360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 N SHACKLEFORD RD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722112840",
            "telephone_number": "501-712-2571",
            "fax_number": "501-404-7789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 N SHACKLEFORD RD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722112840",
            "telephone_number": "501-712-2571",
            "fax_number": "501-404-7789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "STACIE",
        "middle_name": "RENEE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-30",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AR",
            "license": "PA-359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shaquita Lashay Smith
• Sharon Smith
• Sharon Annette Smith
• Shauntay Sharee Smith
• Sherrie Elizabeth Smith, A.P.R.N.
• Stephanie Smith
• Summer Elizabeth Smith
• Teresa Smith, ANP
• Terrinisha Smith, BS
• Tiffany Smith

• Medical Physician Assistant in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Medical Physician Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; 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.