Rhonda Michelle Smith, PHYSICIAN ASSISTANT

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA14435 Issued in CA

Practice address

1300 Mable Avenue
Suite 2
Modesto, CA 95355

Phone

(209) 571-1992

Fax

(209) 571-1994

NPI assigned

May 22, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Rhonda Michelle Johnson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1211414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354060800000",
    "number": "1649437997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 MABLE AVENUE",
            "address_2": "SUITE 2",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "95355",
            "telephone_number": "209-571-1992",
            "fax_number": "209-571-1994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 MABLE AVENUE",
            "address_2": "SUITE 2",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "95355",
            "telephone_number": "209-571-1992",
            "fax_number": "209-571-1994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "RHONDA",
        "middle_name": "MICHELLE",
        "name_prefix": "Ms.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-22",
        "last_updated": "2012-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA14435",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA LICENSE",
            "identifier": "PA14435",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RHONDA",
            "last_name": "JOHNSON",
            "middle_name": "MICHELLE",
            "credential": "PHYSICIAN ASSISTANT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kalysa Smith
• Katherine Elizabeth Smith, LCSW
• Kimberly Anne Smith, PPS
• Lauren Smith
• Maelena Rico Smith
• Samantha Smith
• Scott Smith, M.D.
• Shamanne L Smith
• Sharon E Smith
• Shawn Smith

• Medical Physician Assistant in Modesto, CA
• Providers in Modesto, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.