Active NPI
Kevin Donald Smith, MD
- Pediatric Critical Care Medicine Physician
- Chicago, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Critical Care Medicine Physician
- License
- 036.164127
- Practice address
- 5841 S Maryland Ave # Mc1145
Chicago, IL 60637-1443 - Phone
- (773) 702-3020
- NPI assigned
- Mar 25, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Critical Care Medicine Physician | 2080P0203X | C7-0007316 | DE | |
| Pediatric Emergency Medicine (Pediatrics) Physician | 2080P0204X | DR.0062439 | CO | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatric Critical Care Medicine Physician | 2080P0203X | 036.164127 | IL | Primary |
Addresses
Primary practice location
5841 S Maryland Ave # Mc1145
Chicago, IL 60637-1443
Mailing address
180 Harvester Dr Ste 110
Burr Ridge, IL 60527-6686
Phone (773) 702-1150
Other practice location 1
1600 Rockland Rd
Wilmington, DE 19803-3607
Phone (302) 651-4029
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C7-0007316 | DE | MD | Pediatric Critical Care Medicine Physician |
| 036.164127 | IL | MD | Pediatric Critical Care Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Chicago | Current | Accepting new patients | |
| The University of Chicago Medical Center | Current | Accepting new patients | |
| The University of Chicago Medical Center | Current | Accepting new patients |
Locations
180 Harvester Dr
Ste 110
Burr Ridge, IL 60527
Phone (773) 702-1061
150 Harvester Dr
Ste 300
Burr Ridge, IL 60527
Phone (773) 702-1061
350 N Wall St
Kankakee, IL 60901
Phone (815) 935-7500
120 N Oak St
Oak Brook Mall, IL 60521
Phone (630) 856-6700
Interoperability endpoints
- ksmithmd274858@uchospital.direct-ci.com
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.
-
- General Acute Care Hospital
- Chicago, IL
- NPI 1033218128
-
- Multi-Specialty Clinic/Center
- Chicago, IL
- NPI 1821048786
-
- Community/Retail Pharmacy
- Calumet City, IL
- NPI 1255895678
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458864000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684454400000",
"number": "1649632993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "180 HARVESTER DR STE 110",
"city": "BURR RIDGE",
"state": "IL",
"postal_code": "605276686",
"telephone_number": "773-702-1150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5841 S MARYLAND AVE # MC1145",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606371443",
"telephone_number": "773-702-3020"
}
],
"practiceLocations": [
{
"address_1": "1600 Rockland Rd",
"address_purpose": "LOCATION",
"city": "Wilmington",
"state": "DE",
"postal_code": "198033607",
"country_code": "US",
"telephone_number": "302-651-4029",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SMITH",
"first_name": "KEVIN",
"middle_name": "DONALD",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-03-25",
"last_updated": "2023-05-19",
"certification_date": "2023-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0203X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Critical Care Medicine",
"state": "DE",
"license": "C7-0007316",
"primary": false
},
{
"code": "2080P0204X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Emergency Medicine",
"state": "CO",
"license": "DR.0062439",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2080P0203X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Critical Care Medicine",
"state": "IL",
"license": "036.164127",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2023; 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.