NPIMap

Organization Active NPI

Sam P Smith DO LLC

Doing business as Sam P Smith DO

  • Dermatology Physician
  • Gilbert, AZ
National Provider Identifier
1710904636
Registry record updated Aug 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
4237 Issued in AZ
Legal business name
SAM P SMITH DO LLC
Doing business as
Sam P Smith DO
Practice address
4915 E Baseline Rd
Suite 102
Gilbert, AZ 85234-2965
Phone
(480) 646-8660
Fax
(480) 646-8665
NPI assigned
Jul 16, 2006
Last updated
Aug 16, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2013

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

Authorized official

Name
Dr. Sam P Smith, D.O.NPI 1962420315
Title
President
Phone
(602) 369-6845

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
Dermatology Physician 207N00000X 4237 AZ Primary

Addresses

Primary practice location

4915 E Baseline Rd
Suite 102
Gilbert, AZ 85234-2965

Mailing address

4915 E Baseline Rd
Suite 102
Gilbert, AZ 85234-2965
Phone (480) 646-8660

Other names 1

  • Sam P Smith DO Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061005000016 AZ Part B Supplier - Clinic/Group Practice 3870599426 Receives reassigned benefits from 2 practitioners
Practice locations: Gilbert, AZ

National Provider Directory

National Provider Directory

Locations

4915 E Baseline Rd
Ste 102
Gilbert, AZ 85234
Phone (480) 646-8660

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376611200000",
    "number": "1710904636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4915 E BASELINE RD",
            "address_2": "SUITE 102",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342965",
            "telephone_number": "480-646-8660",
            "fax_number": "480-646-8665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4915 E BASELINE RD",
            "address_2": "SUITE 102",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342965",
            "telephone_number": "480-646-8660",
            "fax_number": "480-646-8665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAM P SMITH DO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2013-08-16",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "SAM",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "602-369-6845",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "AZ",
            "license": "4237",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sam P Smith DO",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gilbert, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2013; 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.