Individual provider Active NPI

Amanda C Smith, OT

  • Occupational Therapy Assistant
  • Worcester, MA
National Provider Identifier
1891434510
Registry record updated Jun 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
4214 Issued in MA
Practice address
50 Gold Star Blvd
Worcester, MA 01606-2812
Phone
(508) 856-9510
Fax
(508) 853-1907
NPI assigned
Jun 1, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 4214 MA Primary

Addresses

Primary practice location

50 Gold Star Blvd
Worcester, MA 01606-2812

Mailing address

50 Gold Star Blvd
Worcester, MA 01606-2812
Phone (508) 856-9510

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220811000516 MA Practitioner - Occupational Therapist in Private Practice 1951784743 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4214MAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Reliant Medical Group, Inc CurrentSince Jul 25, 2022 Accepting new patients
Reliant Medical Group, Inc Past Accepting new patients

Locations

5 Neponset St
Fl 12
Worcester, MA 01606
Phone (508) 852-6175

5 Neponset St
Worcester, MA 01606
Phone (508) 595-2300

Interoperability endpoints

  • Direct secure messaging: amanda.smith.npi1891434510.reliant@direct.optumcare.masshiway.net

Organizations & group practices 2

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": "1654041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654041600000",
    "number": "1891434510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 GOLD STAR BLVD",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016062812",
            "telephone_number": "508-856-9510",
            "fax_number": "508-853-1907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 GOLD STAR BLVD",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016062812",
            "telephone_number": "508-856-9510",
            "fax_number": "508-853-1907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "AMANDA",
        "middle_name": "C",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-01",
        "last_updated": "2022-06-01",
        "certification_date": "2022-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "MA",
            "license": "4214",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.