Peter J Smith, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

616 Issued in CO

Practice address

5715 Kittery Dr
Siute B
Colorado Springs, CO 80911-3552

Phone

(719) 392-3883

Fax

(719) 390-7030

NPI assigned

Apr 29, 2008

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

Enrolled in CO

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Dynamic Family Medicine PLLC

  • Family Medicine Physician
  • Colorado Springs, CO
  • NPI 1639609894
  Medicare reassignment

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

{
    "created_epoch": "1209427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209427200000",
    "number": "1710152962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5715 KITTERY DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809113551",
            "telephone_number": "719-392-3883",
            "fax_number": "719-390-7030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5715 KITTERY DR",
            "address_2": "SIUTE B",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809113552",
            "telephone_number": "719-392-3883",
            "fax_number": "719-390-7030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "PETER",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-29",
        "last_updated": "2008-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miranda Smith
• Nancy A Smith, MSW.LCSW
• Nicholas John Smith, D.C.
• Noel Smith, RBT
• Paul Smith
• Quinda C Smith, MSW, LSW
• Rachael Smith, LCSW
• Ranveig Smith
• Rarico Smith
• Realiti A'Prince Smith

• Physician Assistant in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2008; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.