Individual provider Active NPI

Loren E Smith II, PA-C

  • Physician Assistant
  • Lebanon, MO
National Provider Identifier
1659334514
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50-002369 Issued in OH
Practice address
341 Hospital Dr
Lebanon, MO 65536-9217
Phone
(417) 532-7850
Fax
(417) 532-2451
NPI assigned
Apr 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50-002369 OH Primary

Addresses

Primary practice location

341 Hospital Dr
Lebanon, MO 65536-9217

Mailing address

30713 Highway BB
Lebanon, MO 65536-8255
Phone (417) 532-7045

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, MO, MI3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20060406000175 OH Practitioner - Physician Assistant 8729097555 Reassigns benefits to 2 organizations
I20070605000470 MO Practitioner - Physician Assistant 8729097555 Reassigns benefits to 1 organization
I20211201001336 MI Practitioner - Physician Assistant 8729097555 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
50-002369OHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Hometown Urgent Care of Michigan, P.C. Current Accepting new patients
Hometown Urgent Care of Michigan, P.C. CurrentSince Jan 8, 2024 Accepting new patients
Hometown Urgent Care of Michigan, PC CurrentSince Jan 8, 2024 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Aug 15, 2008 Accepting new patients
Physicians Immediate Care LTD Past Accepting new patients
Emergency Medicine Physicians of Richland County, LTD Past Accepting new patients
Family Health Associates, P.C. Past Accepting new patients

Locations

1131 M 32 W
Alpena, MI 49707
Phone (989) 250-1925

1634 Gull Rd
Kalamazoo, MI 49048
Phone (269) 903-2835

6210 Brandt Pike
Huber Heights, OH 45424
Phone (937) 236-8630

Organizations & group practices 10

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": "1144627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1659334514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30713 HIGHWAY BB",
            "city": "LEBANON",
            "state": "MO",
            "postal_code": "655368255",
            "telephone_number": "417-532-7045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "341 HOSPITAL DR",
            "city": "LEBANON",
            "state": "MO",
            "postal_code": "655369217",
            "telephone_number": "417-532-7850",
            "fax_number": "417-532-2451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "LOREN",
        "middle_name": "E",
        "name_suffix": "II",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50-002369",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, MO

Sources for this page

Verify at the official NPI Registry.