NPIMap

Individual provider Active NPI

Brett A Smith, PA-C

  • Medical Physician Assistant
  • Soda Springs, ID
National Provider Identifier
1932180668
Registry record updated Oct 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA-422 Issued in ID
Practice address
300 S 3Rd W
Soda Springs, ID 83276-1559
Phone
(208) 547-3118
Fax
(208) 547-0424
NPI assigned
Nov 9, 2005
Last updated
Oct 12, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA-422 ID Primary

Addresses

Primary practice location

300 S 3Rd W
Soda Springs, ID 83276-1559

Mailing address

300 S 3Rd W
Soda Springs, ID 83276-1559
Phone (208) 547-3341

Other identifiers 1

IdentifierTypeStateIssuer
1548930878MedicaidID

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bsmith@cmh.securechart.com Direct Caribou Medical Center, Inc

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20100330000573 ID Practitioner - Physician Assistant 6002942943 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Caribou Memorial HospitalGroup PAC ID 6103734777, 15 clinicians
Caribou Medical Center, IncGroup PAC ID 7618365701, 35 clinicians

Practice addresses (Care Compare)

300 S 3Rd
Soda Springs, ID 83276-1559

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Caribou Medical Center, Inc CurrentSince Dec 29, 2021 Accepting new patients
Caribou Medical Center, Inc CurrentSince Dec 29, 2021 Accepting new patients
Caribou Medical Center, Inc PastSince Sep 20, 2022 Accepting new patients

Locations

300 S 3rd W
Soda Springs, ID 83276
Phone (208) 547-0700

Interoperability endpoints

  • Direct secure messaging: bsmith@cmh.securechart.com

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 6

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": "1131494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665532800000",
    "number": "1932180668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 S 3RD W",
            "city": "SODA SPRINGS",
            "state": "ID",
            "postal_code": "832761559",
            "telephone_number": "208-547-3341",
            "fax_number": "208-547-2790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S 3RD W",
            "city": "SODA SPRINGS",
            "state": "ID",
            "postal_code": "832761559",
            "telephone_number": "208-547-3118",
            "fax_number": "208-547-0424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "BRETT",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-09",
        "last_updated": "2022-10-12",
        "certification_date": "2022-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA-422",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1548930878",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bsmith@cmh.securechart.com",
            "affiliation": "Y",
            "affiliationName": "Caribou Medical Center, Inc",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "300 S 3rd W",
            "city": "Soda Springs",
            "state": "ID",
            "country_code": "US",
            "postal_code": "832761559",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Soda Springs, ID

Sources for this page

Verify at the official NPI Registry.