Kelvin Russell Smith II, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

433 West Central Ave
Suite B
Jamestown, TN 38556-3855

Phone

(931) 879-4066

Fax

(931) 879-4071

NPI assigned

Feb 22, 2021

Last updated

Feb 22, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Peak Performance Rehabilitation, Inc

  • Physical Therapy Clinic/Center
  • Wartburg, TN
  • NPI 1831220037
  NPD (past)

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

{
    "created_epoch": "1613952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613952000000",
    "number": "1861086746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 INDUSTRIAL LN",
            "city": "ONEIDA",
            "state": "TN",
            "postal_code": "378416311",
            "telephone_number": "423-569-3443",
            "fax_number": "423-569-2616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 WEST CENTRAL AVE",
            "address_2": "SUITE B",
            "city": "JAMESTOWN",
            "state": "TN",
            "postal_code": "385563855",
            "telephone_number": "931-879-4066",
            "fax_number": "931-879-4071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KELVIN",
        "middle_name": "RUSSELL",
        "name_suffix": "II",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-22",
        "last_updated": "2021-02-22",
        "certification_date": "2021-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Micah Sellew
• Christopher Samuel Sewell, M.D.
• Sisco Family Dentistry (Jamestown Family Dentistry)
• Jennifer Smith
• Jordan D Smith, O.D.
• Misty Dawn Smith
• Travis Dean Smith
• State of Tennessee (Fentress County Health Department)
• Summit Medical Group, PLLC (Sewell Family Practice, a division of Summit Medical Group)
• Support Private Duty Care

• Physical Therapist in Jamestown, TN
• Providers in Jamestown, TN by specialty
• Physical Therapist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.