Kathleen M Smith, MD

Primary specialty

Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X

License

MD26976 Issued in OR

Practice address

10690 NE Cornell Rd Ste 220
Hillsboro, OR 97124-9224

Phone

(503) 848-5861

NPI assigned

Jul 21, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WA, OR2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Pediatric Medicine

Education

Temple University School of Medicine, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Legacy Clinics LLCGroup PAC ID 0244144004, 714 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Legacy Clinics LLC

  • Clinic/Center
  • Portland, OR
  • NPI 1902827272

  WA

  Medicare reassignment Care Compare group NPD
• Legacy Clinics LLC

  • Rural Health Clinic/Center
  • Sandy, OR
  • NPI 1730472192
  NPD (past)
• Neighborhood Health Center

  • Federally Qualified Health Center (FQHC)
  • Milwaukie, OR
  • NPI 1083984264

  Pediatrics

  NPD (past)
• Neighborhood Health Center

  • Federally Qualified Health Center (FQHC)
  • Oregon City, OR
  • NPI 1457902561
  NPD (past)
• Children'S Hospital & Regional Medical Center 2

  • Children's Hospital
  • Seattle, WA
  • NPI 1083789630
  NPD (past)
• The Association of Chrmc and University Physicians

  • Pediatrics Physician
  • Seattle, WA
  • NPI 1255449963

  Pediatric Emergency Medicine

  NPD (past)

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632355200000",
    "number": "1699796201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 CHILDRENS WAY # MC5075",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234223",
            "telephone_number": "858-966-8036",
            "fax_number": "858-966-7433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10690 NE CORNELL RD STE 220",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971249224",
            "telephone_number": "503-848-5861"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3020 Childrens Way",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921234223",
            "country_code": "US",
            "telephone_number": "858-966-8036",
            "fax_number": "858-966-7433",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KATHLEEN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-21",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PP0204X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Pediatric Emergency Medicine",
            "state": "CA",
            "license": "G55045",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "OR",
            "license": "MD26976",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "MD26976",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "298528",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8129355",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dana Sainsbury Smith, M.D.
• Ellamae Ann Smith
• Erik Gordon Smith, D.D.S.
• Jeremy Ryan Smith, LMT
• John D Smith, DMD
• Mandalyn Smith, PA-C
• Nicole Smith, RN
• Rebecca Nicole Smith, REBECCA SMITH, MD
• Roger Garrett Smith, MD
• Ryan Smith, DDS

• Pediatric Emergency Medicine (Pediatrics) Physician in Hillsboro, OR
• Providers in Hillsboro, OR by specialty
• Pediatric Emergency Medicine (Pediatrics) Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.