Individual provider Active NPI

Courtney Anne Smith, M.D.

  • Pediatrics Physician
  • San Antonio, TX
National Provider Identifier
1891053484
Registry record updated Sep 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
Q3443 Issued in TX
Practice address
21727 Ih 10 West
San Antonio, TX 78256-1161
Phone
(210) 698-7663
Fax
(210) 698-7696
NPI assigned
May 2, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X Q3443 TX Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

21727 Ih 10 West
San Antonio, TX 78256-1161

Mailing address

333 N Santa Rosa St
Suite D4023
San Antonio, TX 78207-3108
Phone (469) 282-2711

Other identifiers 1

IdentifierTypeStateIssuer
347893503MedicaidTX

Other names 1

  • Courtney Anne Craig Former name

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20150721000472 TX Practitioner - Pediatric Medicine 5991018913 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
Q3443TXMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Christus Trinity Clinic Texas CurrentSince Mar 16, 2022 Accepting new patients
Baylor College of Medicine Pediatrics CurrentSince Jul 1, 2015 Accepting new patients
Christus Trinity Clinic Texas Pediatrics CurrentSince Mar 16, 2022 Accepting new patients

Locations

333 N Santa Rosa
San Antonio, TX 78207
Phone (210) 704-2190

21727 Ih 10 W
Ste 205
San Antonio, TX 78257
Phone (210) 698-7663

333 N Santa Rosa
Ste D4023
San Antonio, TX 78207

630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888

Interoperability endpoints

  • Direct secure messaging: csmith282952@christushealth.direct-ci.net

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1335916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474070400000",
    "number": "1891053484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 N SANTA ROSA ST",
            "address_2": "SUITE D4023",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782073108",
            "telephone_number": "469-282-2711",
            "fax_number": "469-282-2609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21727 IH 10 WEST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782561161",
            "telephone_number": "210-698-7663",
            "fax_number": "210-698-7696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "COURTNEY",
        "middle_name": "ANNE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-02",
        "last_updated": "2016-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "Q3443",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "347893503",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COURTNEY",
            "last_name": "CRAIG",
            "middle_name": "ANNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.