Organization Active NPI

Kenneth R Smith MD PLLC

  • Ophthalmology Physician
  • Louisville, KY
National Provider Identifier
1679688915
Registry record updated Jul 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
KENNETH R SMITH MD PLLC
Practice address
9700 Park Plaza Ave Unit 103
Louisville, KY 40241-2286
Phone
(502) 429-3937
Fax
(502) 429-3996
NPI assigned
Aug 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2010

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

Authorized official

Name
Dr. Kenneth R Smith, MDNPI 1386619021
Title
Owner
Phone
(502) 429-3937

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

9700 Park Plaza Ave Unit 103
Louisville, KY 40241-2286

Mailing address

9700 Park Plaza Ave Unit 103
Louisville, KY 40241-2286
Phone (502) 429-3937

Other identifiers 1

IdentifierTypeStateIssuer
DC1334OtherKYRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040211000319 KY Part B Supplier - Clinic/Group Practice 3678467693 Receives reassigned benefits from 1 practitioner
Practice locations: Louisville, KY

National Provider Directory

National Provider Directory

Locations

9700 Park Plaza Ave
Unit 103
Louisville, KY 40241
Phone (502) 429-3937

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278979200000",
    "number": "1679688915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9700 PARK PLAZA AVE UNIT 103",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402412286",
            "telephone_number": "502-429-3937",
            "fax_number": "502-429-3996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9700 PARK PLAZA AVE UNIT 103",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402412286",
            "telephone_number": "502-429-3937",
            "fax_number": "502-429-3996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH R SMITH MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-19",
        "last_updated": "2010-07-13",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "502-429-3937",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DC1334",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.