Active NPI
Adrienne Michelle Smith, P.A.
- Physician Assistant
- Rome, NY
National Provider Identifier
1932118684
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 011376
- Practice address
- 1801 Black River Blvd N
Rome, NY 13440-2427 - Phone
- (315) 337-3770
- Fax
- (315) 337-7614
- NPI assigned
- Aug 5, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 011376 | NY | Primary |
Addresses
Primary practice location
1801 Black River Blvd N
Rome, NY 13440-2427
Mailing address
1801 Black River Blvd N
Rome, NY 13440-2427
Phone (315) 337-3770
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 011376 | Other | NY | NEW YORK STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011376 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1932118684",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1801 BLACK RIVER BLVD N",
"city": "ROME",
"state": "NY",
"postal_code": "134402427",
"telephone_number": "315-337-3770",
"fax_number": "315-337-7614"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1801 BLACK RIVER BLVD N",
"city": "ROME",
"state": "NY",
"postal_code": "134402427",
"telephone_number": "315-337-3770",
"fax_number": "315-337-7614"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "ADRIENNE",
"middle_name": "MICHELLE",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "011376",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEW YORK STATE LICENSE",
"identifier": "011376",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rome, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.