NPIMap

Individual provider Active NPI

Willie W Smith III, PA-C

  • Physician Assistant
  • Ronceverte, WV
National Provider Identifier
1902231830
Registry record updated Sep 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
01526 Issued in WV
Practice address
1521 Maplewood Ave
Ronceverte, WV 24970-8026
Phone
(304) 647-5642
Fax
(304) 793-5643
NPI assigned
Sep 11, 2013
Last updated
Sep 16, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 01526 WV Primary

Addresses

Primary practice location

1521 Maplewood Ave
Ronceverte, WV 24970-8026

Mailing address

176 Dawkins Dr
Lewisburg, WV 24901-9302
Phone (304) 647-4411

Other practice location 1

302 Carriage Dr
Beckley, WV 25801-2812
Phone (304) 647-5642

Other practice location 2

1320 Maplewood Ave
Ronceverte, WV 24970-8016
Phone (304) 647-5642

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address willie.smith.1@2276.direct.athenahealth.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131115001657 WV Practitioner - Physician Assistant 8022244284 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
May accept Medicare assignment
Group practices

Practice addresses (Care Compare)

1521 Maplewood Ave
Ronceverte, WV 24970-8026
Phone (304) 647-5642

302 Carriage Dr
Beckley, WV 25801-2812
Phone (304) 647-5642

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.94 of 100Reported as apm
Quality
69.71
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Camc Greenbrier Valley Medical Center Inc CurrentSince Jan 1, 2023 Accepting new patients
Camc Greenbrier Valley Medical Center, Inc. CurrentSince Jan 1, 2023 Accepting new patients
Greenbrier VMC LLC Past Accepting new patients

Locations

302 Carriage Dr
Beckley, WV 25801
Phone (304) 250-0333

176 Dawkins Dr
Lewisburg, WV 24901
Phone (304) 645-6083

231 Dawkins Dr
Lewisburg, WV 24901
Phone (304) 645-0870

1320 Maplewood Ave
Ronceverte, WV 24970
Phone (304) 645-0870

1521 Maplewood Ave
Ronceverte, WV 24970

55 Friends R Fun Dr
Summersville, WV 26651
Phone (304) 645-0870

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1378857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600214400000",
    "number": "1902231830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "176 DAWKINS DR",
            "city": "LEWISBURG",
            "state": "WV",
            "postal_code": "249019302",
            "telephone_number": "304-647-4411",
            "fax_number": "304-793-5643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1521 MAPLEWOOD AVE",
            "city": "RONCEVERTE",
            "state": "WV",
            "postal_code": "249708026",
            "telephone_number": "304-647-5642",
            "fax_number": "304-793-5643"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "302 Carriage Dr",
            "address_purpose": "LOCATION",
            "city": "Beckley",
            "state": "WV",
            "postal_code": "258012812",
            "country_code": "US",
            "telephone_number": "304-647-5642",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1320 Maplewood Ave",
            "address_purpose": "LOCATION",
            "city": "Ronceverte",
            "state": "WV",
            "postal_code": "249708016",
            "country_code": "US",
            "telephone_number": "304-647-5642",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "WILLIE",
        "middle_name": "W",
        "name_suffix": "III",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-09-11",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "01526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "willie.smith.1@2276.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1521 Maplewood Ave",
            "city": "Ronceverte",
            "state": "WV",
            "country_code": "US",
            "postal_code": "249708026",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Ronceverte, WV

Sources for this page

Verify at the official NPI Registry.