Individual provider Active NPI

Kelley Leanne Smart, LCSW

  • Clinical Social Worker
  • Anchorage, AK
National Provider Identifier
1639419161
Registry record updated Apr 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
103100 Issued in AK
Practice address
3300 Providence Dr
Suite B314
Anchorage, AK 99508-4690
Phone
(907) 212-3420
Fax
(907) 212-3429
NPI assigned
Feb 20, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 103100 AK Primary

Addresses

Primary practice location

3300 Providence Dr
Suite B314
Anchorage, AK 99508-4690

Mailing address

PO Box 4105
Portland, OR 97208-4105
Phone (866) 907-1068

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160606000506 AK Practitioner - Clinical Social Worker 4385934256 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Health and Services - WashingtonGroup PAC ID 8628965910, 47 clinicians

Practice addresses (Care Compare)

3760 Piper St
Suite 1108a
Anchorage, AK 99508-4683
Phone (907) 212-6900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
103100AKMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Washington CurrentSince Jun 1, 2021 Accepting new patients
Providence Health & Services- Washington Clinical CurrentSince Apr 12, 2016 Accepting new patients

Locations

3760 Piper St
Ste 1108A
Anchorage, AK 99508
Phone (907) 212-6900

3300 Providence Dr
Ste B314
Anchorage, AK 99508
Phone (907) 212-3420

920 Compassion Cir
Anchorage, AK 99504
Phone (907) 212-9200

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1361318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461801600000",
    "number": "1639419161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4105",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972084105",
            "telephone_number": "866-907-1068",
            "fax_number": "425-917-9141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 PROVIDENCE DR",
            "address_2": "SUITE B314",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995084690",
            "telephone_number": "907-212-3420",
            "fax_number": "907-212-3429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMART",
        "first_name": "KELLEY",
        "middle_name": "LEANNE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-20",
        "last_updated": "2016-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AK",
            "license": "103100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anchorage, AK

Sources for this page

Verify at the official NPI Registry.