Active NPI
Dale M Smith, D.P.M.
- Podiatrist
- Chicago, IL
National Provider Identifier
1831197052
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 016002624
- Practice address
- 1030 N State St Apt 49B
Chicago, IL 60610-2839 - Phone
- (312) 810-7476
- NPI assigned
- Jul 12, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Podiatrist | 213E00000X | 016002624 | IL | Primary |
Addresses
Primary practice location
1030 N State St Apt 49B
Chicago, IL 60610-2839
Mailing address
5405 W 95TH St
Oak Lawn, IL 60453-2349
Phone (708) 425-7476
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 016002624 | Medicaid | IL |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 016002624 | IL | MD | Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ankle N Foot Centers LLC | Podiatrist | Past | Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/25065/brand/1/csg/1/fhir/r4
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.
-
- Durable Medical Equipment & Medical Supplies
- Chicago, IL
- NPI 1053797886
Podiatrist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738627200000",
"number": "1831197052",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5405 W 95TH ST",
"city": "OAK LAWN",
"state": "IL",
"postal_code": "604532349",
"telephone_number": "708-425-7476",
"fax_number": "708-425-4223"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1030 N STATE ST APT 49B",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606102839",
"telephone_number": "312-810-7476"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "DALE",
"middle_name": "M",
"credential": "D.P.M.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-07-12",
"last_updated": "2025-02-04",
"certification_date": "2025-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "IL",
"license": "016002624",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "016002624",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.