Jimmy Reece Smith

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

4026120 Issued in KY

Practice address

384 Mount Everest Way
Bowling Green, KY 42104-8569

Phone

(615) 719-0458

NPI assigned

Jul 4, 2022

Last updated

Dec 4, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in KY, IN2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Lake Substance Abuse Solutions LLCGroup PAC ID 8123440401, 20 clinicians

Daviess County HospitalGroup PAC ID 1557271665, 67 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Daviess County Hospital

  dba Daviess County Hospital Physicians

  • General Acute Care Hospital
  • Washington, IN
  • NPI 1619154820
  Medicare reassignment Care Compare group NPD
• Lake Substance Abuse Solutions LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Jeffersonville, IN
  • NPI 1124598669

  KY

  Medicare reassignment Care Compare group NPD
• Daviess County Hospital

  dba Daviess Community Hospital Orthopaedics

  • Orthopaedic Surgery Physician
  • Washington, IN
  • NPI 1083915326
  NPD
• Daviess County Hospital

  dba Daviess Community Hospital Montgomery Medical Clinic

  • Rural Health Clinic/Center
  • Montgomery, IN
  • NPI 1336959279
  NPD

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

{
    "created_epoch": "1656892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733270400000",
    "number": "1629701032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1143 FAIRWAY ST STE 103",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421032452",
            "telephone_number": "407-347-4536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "384 MOUNT EVEREST WAY",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421048569",
            "telephone_number": "615-719-0458"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1143 Fairway St Ste 103",
            "address_purpose": "LOCATION",
            "city": "Bowling Green",
            "state": "KY",
            "postal_code": "421032452",
            "country_code": "US",
            "telephone_number": "407-347-4536",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JIMMY",
        "middle_name": "REECE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-07-04",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "KY",
            "license": "4026120",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "KY",
            "license": "1099382",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KY BOARD OF NURSING",
            "identifier": "1099382",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jsmith@skyrehab.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "BOWLING GREEN",
            "address_1": "384 Mount Everest Way",
            "city": "Bowling Green",
            "state": "KY",
            "country_code": "US",
            "postal_code": "421048569",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• David Glenn Smith, MD LLC
• David M Smith, M.D.
• Elizabeth Danielle Smith
• Eric Monroe Smith, PT
• Gabriela Smith
• John Christopher Smith, M.D.
• Julianne Smith
• Kaitlyn Smith
• Kayla J. Smith, DNP, APRN, FNP-BC
• Kimberly Jean Smith, M.S. CCC-SLP

• Psychiatric/Mental Health Nurse Practitioner in Bowling Green, KY
• Providers in Bowling Green, KY by specialty
• Psychiatric/Mental Health Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2024; 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.