Denise M Smith, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

02001605 Issued in IN

Practice address

1211 W State Blvd
Fort Wayne, IN 46808-3103

Phone

(260) 422-0010

Fax

(260) 422-2212

NPI assigned

Jul 27, 2005

Reactivated

Apr 17, 2006

Sex

Female

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 2

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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.

• Emergency Medicine of Indiana

  • Emergency Medicine Physician
  • Fort Wayne, IN
  • NPI 1952356883
  NPD (past)
• Redimed Dekalb LLC

  • General Practice Physician
  • Auburn, IN
  • NPI 1669417457
  NPD (past)
• St. Joseph Health System, LLC

  • Medicare Defined Swing Bed Hospital Unit
  • Fort Wayne, IN
  • NPI 1538812946
  NPD (past)

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

{
    "created_epoch": "1122422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635811200000",
    "number": "1912907445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 W STATE BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468083103",
            "telephone_number": "260-422-0010",
            "fax_number": "260-422-2212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 W STATE BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468083103",
            "telephone_number": "260-422-0010",
            "fax_number": "260-422-2212"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7333 W Jefferson Blvd",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468046280",
            "country_code": "US",
            "telephone_number": "260-458-3830",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "DENISE",
        "middle_name": "M",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-27",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "deactivation_date": "2006-03-21",
        "reactivation_date": "2006-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02001605",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200023850",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080175244",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "denise.smith@lutheranhealthnetwork.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "7333 W Jefferson Blvd",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468046280",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "redimedsouthwest@docutapdirect.com",
            "affiliation": "N",
            "endpointDescription": "DocuTAP direct address",
            "address_1": "7333 W Jefferson Blvd",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468046280",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Corbett M Smith, MD
• Daniel Paul Smith, RPH
• Darryl Smith
• David Allen Smith, M.D.
• Dawn Ja'Ney Smith, LMHC-A
• Donald F Smith, ACSW, LCSW
• Elisabeth Smith
• Gregory Lee Smith, RPH
• Heather Smith
• Jenna Rae Smith

• Family Medicine Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.