Ian Michael Smith

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2017022695 Issued in MO

Practice address

2275 Sommers Rd
Lake St Louis, MO 63367-6406

Phone

(636) 561-0075

NPI assigned

Feb 10, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1581292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581292800000",
    "number": "1922630607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 ROCK BRIDGE RD",
            "city": "VILLA RIDGE",
            "state": "MO",
            "postal_code": "630892006",
            "telephone_number": "636-221-0091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2275 SOMMERS RD",
            "city": "LAKE ST LOUIS",
            "state": "MO",
            "postal_code": "633676406",
            "telephone_number": "636-561-0075"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6309 Ronald Reagan Dr",
            "address_purpose": "LOCATION",
            "city": "Lake St Louis",
            "state": "MO",
            "postal_code": "633672681",
            "country_code": "US",
            "telephone_number": "636-755-4566",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "IAN",
        "middle_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-10",
        "last_updated": "2020-02-10",
        "certification_date": "2020-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MO",
            "license": "2017022695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Debbie Sharp, LCSW
• Heather Shelton
• Gregory Todd Siegel, M.D.
• Kandice Smith-Green
• Brian M Smith, M.D.
• Olivia Smith, DPT
• Naresh J Solanki, M.D.
• Spartan Physiotherapy
• SSM Health Care St. Louis (SSM Health St. Joseph Hospital - Lake Saint Louis Physician Billing)
• SSM Health Care St. Louis (SSM Health St Joseph Hospital - Lake Saint Louis)

• Athletic Trainer in Lake St Louis, MO
• Providers in Lake St Louis, MO by specialty
• Athletic Trainer in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2020; 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.