Individual provider Active NPI

Jimmy D Smith Jr., FNP

  • Family Nurse Practitioner
  • Prescott, AZ
National Provider Identifier
1629027925
Registry record updated Mar 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP2306 Issued in AZ
Practice address
1001 Willow Creek Rd Ste 2200
Prescott, AZ 86301-1614
Phone
(928) 445-6025
Fax
(928) 778-3026
NPI assigned
May 6, 2006
Last updated
Mar 12, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2025

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 AP2306 AZ Primary

Addresses

Primary practice location

1001 Willow Creek Rd Ste 2200
Prescott, AZ 86301-1614

Mailing address

1001 Willow Creek Rd Ste 2200
Prescott, AZ 86301-1614
Phone (602) 406-4786

Other identifiers 2

IdentifierTypeStateIssuer
084440MedicaidAZ
Z142983OtherAZMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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

Enrollment IDStateProvider typePAC IDDetails
I20060208000074 AZ Practitioner - Nurse Practitioner 7719992023 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1001 Willow Creek Rd
Suite 2200
Prescott, AZ 86301-1614
Phone (928) 445-6025

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP2306AZMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Yavapai Regional Medical Center Physician Care LLC CurrentSince Jan 2, 2011 Accepting new patients
Yavapai Regional Medical Center Physician Care LLC CurrentSince Jan 2, 2011 Accepting new patients
Cedars Cardiovascular Care, P.L.L.C. Past Accepting new patients
Prescott Gastroenterology Past Accepting new patients
Cedars Cardiovascular, P.C. Past Accepting new patients

Locations

726 Gail Gardner Way
Ste B
Prescott, AZ 86305
Phone (520) 455-4100

1001 Willow Creek Rd
Ste 2200
Prescott, AZ 86301
Phone (928) 445-6025

726 Gail Gardner Way
Ste A
Prescott, AZ 86305
Phone (928) 442-8660

3120 Clearwater Dr
Prescott, AZ 86305
Phone (928) 445-4818

Organizations & group practices 5

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 1

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": "1146873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741737600000",
    "number": "1629027925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 WILLOW CREEK RD STE 2200",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011614",
            "telephone_number": "602-406-4786",
            "fax_number": "916-636-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 WILLOW CREEK RD STE 2200",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011614",
            "telephone_number": "928-445-6025",
            "fax_number": "928-778-3026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JIMMY",
        "middle_name": "D",
        "name_suffix": "Jr.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-06",
        "last_updated": "2025-03-12",
        "certification_date": "2025-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP2306",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "084440",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "Z142983",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Prescott, AZ

Sources for this page

Verify at the official NPI Registry.