Individual provider Active NPI

Christopher Lacey Smith, M.D. , PH.D.

  • Pediatric Cardiology Physician
  • Philadelphia, PA
National Provider Identifier
1639517147
Registry record updated Oct 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
MD458818 Issued in PA
Practice address
3401 Civic Center Blvd
9NW63
Philadelphia, PA 19104-4319
Phone
(215) 590-1220
Fax
(215) 590-2768
NPI assigned
Jun 6, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Cardiology Physician 2080P0202X MD458818 PA Primary

Addresses

Primary practice location

3401 Civic Center Blvd
9NW63
Philadelphia, PA 19104-4319

Mailing address

100 E Penn SQ FL 9
Philadelphia, PA 19107-3377
Phone (215) 590-1000

Other identifiers 1

IdentifierTypeStateIssuer
1034955680001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20190926002290 PA Practitioner - Cardiovascular Disease (Cardiology) 6800126236 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD458818PAMDPediatric Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Childen's Health Care Associates Inc. CurrentSince Aug 10, 2019 Accepting new patients
Childrens Health Care Associates, Inc Pediatrics Current Accepting new patients
Childrens Health Care Associates, Inc Pediatric Cardiology CurrentSince Aug 10, 2019 Accepting new patients

Locations

100 E Penn Sq
Fl 9
Philadelphia, PA 19107
Phone (267) 425-9232

3401 Civic Center Blvd
#9
Philadelphia, PA 19104
Phone (215) 590-2437

3401 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-4040

Organizations & group practices 3

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": "1370476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634601600000",
    "number": "1639517147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E PENN SQ FL 9",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191073377",
            "telephone_number": "215-590-1000",
            "fax_number": "215-590-2768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD",
            "address_2": "9NW63",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044319",
            "telephone_number": "215-590-1220",
            "fax_number": "215-590-2768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "CHRISTOPHER",
        "middle_name": "LACEY",
        "name_prefix": "Dr.",
        "credential": "M.D. , PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-06",
        "last_updated": "2021-10-19",
        "certification_date": "2021-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "PA",
            "license": "MD458818",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1034955680001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.