Jack Coldwell Smith III, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

L3131 Issued in TX

Practice address

409 Cottage Rd
Carthage, TX 75633-1466

Phone

(903) 694-4824

Fax

(903) 694-4621

NPI assigned

Jun 19, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jsmith355760@ahs.direct-ci.com

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.

• Etmc Physician Group Inc.

  • Cardiovascular Disease Physician
  • Tyler, TX
  • NPI 1609382662
  Medicare reassignment NPD
• Etmc Physician Group Inc.

  • Rural Health Clinic/Center
  • Chandler, TX
  • NPI 1235706581
  NPD
• Caprock Cardiovascular Center, LLP

  • Cardiovascular Disease Physician
  • Lubbock, TX
  • NPI 1982063269
  NPD (past)
• LHH Emergency Physicians PLLC

  • Emergency Medicine Physician
  • Lubbock, TX
  • NPI 1902855653
  NPD (past)

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683158400000",
    "number": "1871538041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 COTTAGE RD",
            "city": "CARTHAGE",
            "state": "TX",
            "postal_code": "756331466",
            "telephone_number": "036-944-8249",
            "fax_number": "903-694-4621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 COTTAGE RD",
            "city": "CARTHAGE",
            "state": "TX",
            "postal_code": "756331466",
            "telephone_number": "903-694-4824",
            "fax_number": "903-694-4621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JACK",
        "middle_name": "COLDWELL",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-19",
        "last_updated": "2023-05-04",
        "certification_date": "2023-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "L3131",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "159534003",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kendall Russell, FNP-C
• Venkata Samavedi, MD
• Shep Next Step Solutions
• SLP Carthage LLC
• Bernice Smith
• South Limestone Hospital District
• Lauren Stacy
• Amanda Stilley Bickham, FNP-C
• Three Angel'S Covenant Care 'LLC'
• Jessica Alyse Tibbs, OD

• Internal Medicine Physician in Carthage, TX
• Providers in Carthage, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2023; 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.