Individual provider Active NPI

Connor Jameson Smith, PA-C

  • Physician Assistant
  • Jacksonville, FL
National Provider Identifier
1912500109
Registry record updated Jan 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9113850 Issued in FL
Practice address
14534 Old Saint Augustine Rd Ste 3420
Jacksonville, FL 32258-2645
Phone
(904) 493-8001
Fax
(904) 388-0852
NPI assigned
Nov 19, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PAX000017679 FL
Physician Assistant 363A00000X PA9113850 FL Primary

Addresses

Primary practice location

14534 Old Saint Augustine Rd Ste 3420
Jacksonville, FL 32258-2645

Mailing address

PO Box 746652
Atlanta, GA 30374-6652
Phone (047) 200-5999

Other practice location 1

145 City Pl Ste 201
Palm Coast, FL 32164-2480
Phone (888) 481-2135

Other practice location 2

300 Health Park Blvd Ste 1000
St Augustine, FL 32086-3702
Phone (904) 819-2999

Other practice location 3

351 Town Plaza Ave Ste 201
Ponte Vedra, FL 32081-5178
Phone (904) 819-7077

Other practice location 4

120 Health Park Blvd Ste 1
St Augustine, FL 32086-5798
Phone (904) 819-1010

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210216001219 FL Practitioner - Physician Assistant 1254744683 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Baptist Cardiology, Inc.Group PAC ID 2466614581, 98 clinicians

Practice addresses (Care Compare)

14534 Old Saint Augustine Rd
Suite 3420
Jacksonville, FL 32258-2645
Phone (904) 493-8001

836 Prudential Dr
Suite 1700
Jacksonville, FL 32207-8344
Phone (904) 398-0125

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.44 of 100Reported as apm
Quality
84.21
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PAX000017679FLMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: csmith137030@baptisthealthsystemjacksonville.direct-ci.com

Organizations & group practices 1

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1605744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675036800000",
    "number": "1912500109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746652",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746652",
            "telephone_number": "047-200-5999",
            "fax_number": "904-376-4036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14534 OLD SAINT AUGUSTINE RD STE 3420",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322582645",
            "telephone_number": "904-493-8001",
            "fax_number": "904-388-0852"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "145 City Pl Ste 201",
            "address_purpose": "LOCATION",
            "city": "Palm Coast",
            "state": "FL",
            "postal_code": "321642480",
            "country_code": "US",
            "telephone_number": "888-481-2135",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 Health Park Blvd Ste 1000",
            "address_purpose": "LOCATION",
            "city": "St Augustine",
            "state": "FL",
            "postal_code": "320863702",
            "country_code": "US",
            "telephone_number": "904-819-2999",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "351 Town Plaza Ave Ste 201",
            "address_purpose": "LOCATION",
            "city": "Ponte Vedra",
            "state": "FL",
            "postal_code": "320815178",
            "country_code": "US",
            "telephone_number": "904-819-7077",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "120 Health Park Blvd Ste 1",
            "address_purpose": "LOCATION",
            "city": "St Augustine",
            "state": "FL",
            "postal_code": "320865798",
            "country_code": "US",
            "telephone_number": "904-819-1010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "CONNOR",
        "middle_name": "JAMESON",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-11-19",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PAX000017679",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9113850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.