James Ralph Smith, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071-003744 Issued in IL

Practice address

2506 Galen Dr
Suite 103
Champaign, IL 61821-7046

Phone

(217) 398-0744

Fax

(217) 398-0778

NPI assigned

Aug 30, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Christie Clinic, PLLC

  • Internal Medicine Physician
  • Champaign, IL
  • NPI 1871523829
  NPD (past)

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

{
    "created_epoch": "1125360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347840000000",
    "number": "1659364180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2506 GALEN DR",
            "address_2": "SUITE 103",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618217046",
            "telephone_number": "217-398-0744",
            "fax_number": "217-398-0778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2506 GALEN DR",
            "address_2": "SUITE 103",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618217046",
            "telephone_number": "217-398-0744",
            "fax_number": "217-398-0778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JAMES",
        "middle_name": "RALPH",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-30",
        "last_updated": "2012-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071-003744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dionne Vanessa Smith, M.D.
• Doug C Smith
• Gabrielle Smith
• Isabella Ruby Smith, COTA/L
• Jaimee Leeann Smith
• Jeremy A Smith, LSW
• Keyera J Smith
• Leeanne Smith
• Linda Kay Smith, LCSW
• Melissa Anne Smith

• Clinical Psychologist in Champaign, IL
• Providers in Champaign, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.