Active NPI
David Russell Smith, PA
- Physician Assistant
- Reidsville, NC
National Provider Identifier
1679520050
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0010-00863
- Practice address
- 2509 Richardson Dr Ste a
Reidsville, NC 27320-5926 - Phone
- (336) 347-7998
- NPI assigned
- May 30, 2006
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 0010-00863 | NC | |
| Surgical Physician Assistant | 363AS0400X | 2006017175 | MO | |
| Physician Assistant | 363A00000X | 0010-00863 | NC | Primary |
Addresses
Primary practice location
2509 Richardson Dr Ste a
Reidsville, NC 27320-5926
Mailing address
5400 Endrick CT
Greensboro, NC 27409-9564
Phone (919) 616-5704
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0600090 | Other | MO | UNITED HEALTHCARE |
| 209151 | Other | MO | ANTHEM BLUE CROSS/SHIELD |
| 2561566 | Other | MO | COX HEALTH |
| 502277007 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0010-00863 | NC | MD | Physician Assistant |
| 2006017175 | MO | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655164800000",
"number": "1679520050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5400 ENDRICK CT",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274099564",
"telephone_number": "919-616-5704"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2509 RICHARDSON DR STE A",
"city": "REIDSVILLE",
"state": "NC",
"postal_code": "273205926",
"telephone_number": "336-347-7998"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "DAVID",
"middle_name": "RUSSELL",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-30",
"last_updated": "2022-06-14",
"certification_date": "2022-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "NC",
"license": "0010-00863",
"primary": false
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "MO",
"license": "2006017175",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "0010-00863",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "0600090",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BLUE CROSS/SHIELD",
"identifier": "209151",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COX HEALTH",
"identifier": "2561566",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "502277007",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Reidsville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.