Stephen Glen Smith, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9101253 Issued in FL

Practice address

6501 S Ocean Dr
Jensen Beach, FL 34957-2041

Phone

(772) 468-4206

Fax

(772) 468-4270

NPI assigned

Apr 25, 2007

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network

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.

• Physicians Immediate Care Inc

  • Urgent Care Clinic/Center
  • Port St Lucie, FL
  • NPI 1295947323
  NPD
• Premise Health of Florida Medical PA

  • Primary Care Clinic/Center
  • Jensen Beach, FL
  • NPI 1447871967
  NPD (past)

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

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1801015037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1462 SE GRIFFIN TER",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349525414",
            "telephone_number": "772-337-0981",
            "fax_number": "772-335-9941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6501 S OCEAN DR",
            "city": "JENSEN BEACH",
            "state": "FL",
            "postal_code": "349572041",
            "telephone_number": "772-468-4206",
            "fax_number": "772-468-4270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "STEPHEN",
        "middle_name": "GLEN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9101253",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Smart Imaging
• Kenneth J Smeds, MA CCC/SLP
• Patricia F. Smeds, MA, CCC-SLP
• Gary Robert Smith
• Sara Smith, APRN
• Karen R Smouse, OT
• Heather Alicia Snell
• Solaris Rehab, LLC
• Solaris Rehab, LLC
• Solution Focused Therapies Inc

• Physician Assistant in Jensen Beach, FL
• Providers in Jensen Beach, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.