NPIMap

Individual provider Active NPI

Fred Allen Smith Jr., DNP, FNP-C

  • Family Nurse Practitioner
  • Ridgeway, VA
National Provider Identifier
1619524527
Registry record updated Nov 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0024178098 Issued in VA
Practice address
4944 Greensboro Rd
Ridgeway, VA 24148-3390
Phone
(276) 956-2233
NPI assigned
Aug 25, 2019
Last updated
Nov 25, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0024178098 VA Primary

Addresses

Primary practice location

4944 Greensboro Rd
Ridgeway, VA 24148-3390

Mailing address

1007 Summit Ave
Greensboro, NC 27405-7007
Phone (336) 200-7010

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20200106002964 NC Practitioner - Nurse Practitioner 1557795259 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osh Mi Physicians Group, PCGroup PAC ID 7810282191, 154 clinicians

Practice addresses (Care Compare)

1007 Summit Ave
Greensboro, NC 27405-7007
Phone (336) 200-7010

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0024178098VAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Osh-Mi Physicians Group PC Family CurrentSince Oct 28, 2019 Accepting new patients
Osh Mi Physicians Group, PC CurrentSince Oct 28, 2019 Accepting new patients

Locations

30 W Monroe St
Ste 1200
Chicago, IL 60603
Phone (773) 609-1758

3250 Freedom Dr
Charlotte, NC 28208
Phone (704) 394-0118

1007 Summit Ave
Greensboro, NC 27405
Phone (336) 200-7010

Interoperability endpoints

  • Direct secure messaging: fred.smith@oakstreethealth.gwaydirect.com

Organizations & group practices 2

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 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1566691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574640000000",
    "number": "1619524527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 SUMMIT AVE",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274057007",
            "telephone_number": "336-200-7010",
            "fax_number": "704-710-8592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4944 GREENSBORO RD",
            "city": "RIDGEWAY",
            "state": "VA",
            "postal_code": "241483390",
            "telephone_number": "276-956-2233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "FRED",
        "middle_name": "ALLEN",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "DNP, FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-25",
        "last_updated": "2019-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024178098",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgeway, VA

Sources for this page

Verify at the official NPI Registry.