Kimberly Victoria Smith, NP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN201498 Issued in GA

Practice address

1035 Southcrest Dr Ste 250
Stockbridge, GA 30281-6117

Phone

(770) 996-9945

Fax

(770) 996-7355

NPI assigned

Aug 24, 2020

Last updated

Aug 24, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

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

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Preferred Vascular Services SouthwestGroup PAC ID 0446502918, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: peachtreevascular@direct-address.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Preferred Vascular Services Southwest

  • Vascular Surgery Physician
  • Atlanta, GA
  • NPI 1790285229
  Medicare reassignment Care Compare group NPD
• Preferred Vascular Services Macon LLC

  • Vascular Surgery Physician
  • Macon, GA
  • NPI 1437659455
  Medicare reassignment NPD
• Preferred Vascular Services Northeast

  • Vascular Surgery Physician
  • Atlanta, GA
  • NPI 1780184218
  Medicare reassignment NPD
• Preferred Vascular Services Northwest, LLC

  • Vascular Surgery Physician
  • Marietta, GA
  • NPI 1598037822
  Medicare reassignment NPD
• Preferred Vascular Services Southeast LLC

  • Vascular Surgery Physician
  • Lithonia, GA
  • NPI 1861992976
  Medicare reassignment NPD

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

{
    "created_epoch": "1598227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598227200000",
    "number": "1740893411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1035 SOUTHCREST DR STE 250",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302816117",
            "telephone_number": "770-996-9945",
            "fax_number": "770-996-7355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1035 SOUTHCREST DR STE 250",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302816117",
            "telephone_number": "770-996-9945",
            "fax_number": "770-996-7355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KIMBERLY",
        "middle_name": "VICTORIA",
        "name_prefix": "Miss",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-24",
        "last_updated": "2020-08-24",
        "certification_date": "2020-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "GA",
            "license": "RN201498",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN201498",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Peachtreevascular@direct-address.net",
            "affiliation": "N",
            "endpointDescription": "Employer's direct mesaaging",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "1035 Southcrest Dr Ste 250",
            "city": "Stockbridge",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302816117",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Disheca Renee Smith, MA, LPC, NCC
• Elizabeth Nadra Smith, FNP-C
• Gary T Smith, PHYSICAL THERAPIST
• Jordan Smith
• Khalil H. Smith
• Kyra Smith
• Nicole L Smith, NP
• Paul Andrew Smith, DMD
• Peter E Smith, D.P.M.
• Rebecca Anne Smith, CPNP

• Nurse Practitioner in Stockbridge, GA
• Providers in Stockbridge, GA by specialty
• Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2020; 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.