Individual provider Active NPI

Taylor Michael Smith, PA-C, ATC

  • Physician Assistant
  • Jackson, TN
National Provider Identifier
1730798240
Registry record updated Mar 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4638 Issued in TN
Practice address
28 Medical Center Dr
Jackson, TN 38301-3947
Phone
(731) 427-9971
Fax
(731) 427-9973
NPI assigned
Jul 30, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 6, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 4638 TN
Surgical Physician Assistant 363AS0400X 4638 TN
Physician Assistant 363A00000X 4638 TN Primary

Addresses

Primary practice location

28 Medical Center Dr
Jackson, TN 38301-3947

Mailing address

28 Medical Center Dr
Jackson, TN 38301-3947
Phone (731) 427-9971

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20210908001680 TN Practitioner - Physician Assistant 2961808407 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jackson Urological Associates, P.C.Group PAC ID 5395728935, 5 clinicians

Practice addresses (Care Compare)

28 Medical Ctr Dr
Jackson, TN 38301-3947
Phone (731) 427-9971

Hospital & facility affiliations

  • Jackson-Madison County General Hospital Hospital, Jackson, TN, CCN 440002
  • West Tennessee Healthcare Milan Hospital Hospital, Milan, TN, CCN 440060

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as group
Quality
0
Promoting interoperability
0
Improvement activities
0
Cost
0

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
4638TNMDMedical Physician Assistant

Interoperability endpoints

  • Direct secure messaging: tsmith19231@directepic.wth.org
  • Direct secure messaging: taylor.smith.p1@direct.cpc.nextgenshare.com

Organizations & group practices 1

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1596067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709683200000",
    "number": "1730798240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 MEDICAL CENTER DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013947",
            "telephone_number": "731-427-9971",
            "fax_number": "731-427-9973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 MEDICAL CENTER DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013947",
            "telephone_number": "731-427-9971",
            "fax_number": "731-427-9973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "TAYLOR",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "PA-C, ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-07-30",
        "last_updated": "2024-03-06",
        "certification_date": "2024-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TN",
            "license": "4638",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TN",
            "license": "4638",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "4638",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, TN

Sources for this page

Verify at the official NPI Registry.