NPIMap

Individual provider Active NPI

Larry Dean Smith, D.O.

  • Emergency Medicine Physician
  • Omak, WA
National Provider Identifier
1639131386
Registry record updated Aug 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
OP00001346 Issued in WA
Practice address
617 Benton St
Omak, WA 98841
Phone
(509) 422-7416
Fax
(509) 634-2945
NPI assigned
Apr 6, 2006
Last updated
Aug 25, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X OP00001346 WA Primary

Addresses

Primary practice location

617 Benton St
Omak, WA 98841

Mailing address

PO Box 71
Nespelem, WA 99155-0071
Phone (509) 634-2995

Other practice location 1

19 Lakes Street
Nespelem, WA 99155
Phone (509) 422-2900

Other identifiers 3

IdentifierTypeStateIssuer
G8886888OtherWAMEDICARE PTAN
1078310MedicaidWA
0264988OtherL&I

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040608001113 WA Practitioner - Family PracticePractitioner - Orthopedic Surgery 8729061189 Reassigns benefits to 1 organization
I20170724003308 TX Practitioner - Family Practice 8729061189 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Western University of Health Sciences College of Dental Med, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
DHHS IHS Colville Service UnitGroup PAC ID 0941302509, 3 clinicians
Omak Tribal Health ClinicGroup PAC ID 1557458510, 2 clinicians

Practice addresses (Care Compare)

19 Lakes St
Colville Indian Health Center
Nespelem, WA 99155
Phone (509) 634-2900

617 Benton St
Omak, WA 98841-9636
Phone (509) 634-2992

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Okanogan Douglas County Hospital Dist 1 CurrentSince Nov 14, 2009 Accepting new patients
Okanogan Douglas County Hospital Dist1 Emergency Medicine CurrentSince Nov 14, 2009 Accepting new patients
Omak Tribal Health Clinic CurrentSince May 14, 2017 Accepting new patients
DHHS IHS Colville Service Unit CurrentSince Apr 10, 2018 Accepting new patients
Confederated Tribes of the Colville Reservation Past Accepting new patients

Locations

617 Benton St
Omak, WA 98841
Phone (509) 422-7416

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

Hospital & facility affiliations 3

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": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629849600000",
    "number": "1639131386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 71",
            "city": "NESPELEM",
            "state": "WA",
            "postal_code": "991550071",
            "telephone_number": "509-634-2995",
            "fax_number": "509-634-2945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "617 BENTON ST",
            "city": "OMAK",
            "state": "WA",
            "postal_code": "98841",
            "telephone_number": "509-422-7416",
            "fax_number": "509-634-2945"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19 Lakes Street",
            "address_purpose": "LOCATION",
            "city": "Nespelem",
            "state": "WA",
            "postal_code": "99155",
            "country_code": "US",
            "telephone_number": "509-422-2900",
            "fax_number": "509-422-2946",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "LARRY",
        "middle_name": "DEAN",
        "name_prefix": "Mr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-06",
        "last_updated": "2021-08-25",
        "certification_date": "2021-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WA",
            "license": "OP00001346",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "G8886888",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1078310",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "0264988",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Omak, WA

Sources for this page

Verify at the official NPI Registry.