Active NPI
Thomas D. Smith III, M.D.
- Family Medicine Physician
- New Haven, IN
National Provider Identifier
1790762870
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 01027868A
- Practice address
- 1331 Minnich Rd
New Haven, IN 46774-2051 - Phone
- (260) 373-9600
- Fax
- (260) 373-9602
- NPI assigned
- Dec 29, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 01027868A | IN | Primary |
Addresses
Primary practice location
1331 Minnich Rd
New Haven, IN 46774-2051
Mailing address
1234 E Dupont Rd
Suite 3
Fort Wayne, IN 46825-1545
Phone (260) 373-9700
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100053750 | Medicaid | IN | |
| 00001291560 01 | Other | UNITED HEALTHCARE | |
| 080130028 | Other | IN | RAILROAD MEDICARE |
| 4047064 | Other | AETNA | |
| 000000111933 | Other | IN | ANTHEM |
| 1867 | Other | IN | PHYSICIANS HEALTH PLAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135814400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260748800000",
"number": "1790762870",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1234 E DUPONT RD",
"address_2": "SUITE 3",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468251545",
"telephone_number": "260-373-9700",
"fax_number": "260-373-9740"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1331 MINNICH RD",
"city": "NEW HAVEN",
"state": "IN",
"postal_code": "467742051",
"telephone_number": "260-373-9600",
"fax_number": "260-373-9602"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "THOMAS",
"middle_name": "D.",
"name_suffix": "III",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-29",
"last_updated": "2009-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IN",
"license": "01027868A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100053750",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "00001291560 01",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "080130028",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4047064",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000111933",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICIANS HEALTH PLAN",
"identifier": "1867",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in New Haven, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.