Individual provider Active NPI

Brian Samuel Smith, MD

  • Emergency Medicine Physician
  • Lafayette, LA
National Provider Identifier
1629298757
Registry record updated Jan 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
48138 Issued in TN
Practice address
200 Corporate Blvd
Lafayette, LA 70508-3870
Phone
(337) 609-5109
NPI assigned
Apr 30, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 31, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 0101256622 VA
Emergency Medicine Physician 207P00000X 48138 TN Primary

Addresses

Primary practice location

200 Corporate Blvd
Lafayette, LA 70508-3870

Mailing address

415 Broad St
Suite 410
Kingsport, TN 37660-4263
Phone (423) 239-9737

Other practice location 1

3280 Mitchell Blvd
Moody AFB, GA 31699-4263
Phone (229) 257-2778

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, VA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140812001786 TN Practitioner - Emergency Medicine 4688810104 Reassigns benefits to 2 organizations
I20140919000565 VA Practitioner - Emergency Medicine 4688810104 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
East Tennessee State University Quillen College of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tri-Cities Regional Emergency Physicians, PCGroup PAC ID 3678859477, 118 clinicians

Practice addresses (Care Compare)

1 Medical Park Blvd
Bristol, TN 37620-7430
Phone (423) 844-1121

Hospital & facility affiliations

  • Wellmont Bristol Regional Medical Center Hospital, Bristol, TN, CCN 440012

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
48138TNMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tri-Cities Regional Emergency Physicians, PC Emergency Medicine CurrentSince Jun 25, 2021 Accepting new patients
Wellmont Medical Associates Inc CurrentSince Jun 15, 2015 Accepting new patients
Western Virginia Regional Emergency Physicians, LLC Emergency Medicine CurrentSince Dec 14, 2021 Accepting new patients
Wellmont Medical Associates, Inc. CurrentSince Jun 15, 2015 Accepting new patients
Hedera Counseling Center PastSince Oct 27, 2024 Accepting new patients

Locations

200 Corporate Blvd
Lafayette, LA 70508

1 Medical Park Blvd
Ste 210E
Bristol, TN 37620
Phone (423) 224-4000

1 Medical Park Blvd
Bristol, TN 37620
Phone (423) 390-0451

401 Takoma Ave
Greeneville, TN 37743
Phone (423) 639-3151

400 N State of Franklin Rd
Johnson City, TN 37604
Phone (423) 431-1310

111 W Stone Dr
Ste 100
Kingsport, TN 37660
Phone (423) 247-5197

130 W Ravine Rd
Kingsport, TN 37660
Phone (423) 224-3150

105 W Stone Dr
Ste 6A
Kingsport, TN 37660
Phone (423) 408-7220

1519 Main St
Sneedville, TN 37869
Phone (423) 733-5000

1990 Holton Ave E
Big Stone Gap, VA 24219
Phone (276) 523-3111

100 15th St NW
Norton, VA 24273
Phone (276) 439-1000

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 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": "1177891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738281600000",
    "number": "1629298757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 BROAD ST",
            "address_2": "SUITE 410",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604263",
            "telephone_number": "423-239-9737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 CORPORATE BLVD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083870",
            "telephone_number": "337-609-5109"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3280 Mitchell Blvd",
            "address_purpose": "LOCATION",
            "city": "Moody AFB",
            "state": "GA",
            "postal_code": "316994263",
            "country_code": "US",
            "telephone_number": "229-257-2778",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "BRIAN",
        "middle_name": "SAMUEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-30",
        "last_updated": "2025-01-31",
        "certification_date": "2025-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "VA",
            "license": "0101256622",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "48138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, LA

Sources for this page

Verify at the official NPI Registry.