Individual provider Active NPI

Lauren Kendall Smith, PA-C

  • Physician Assistant
  • Hackensack, NJ
National Provider Identifier
1952894339
Registry record updated Dec 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
25MP00724200 Issued in NJ
Practice address
30 Prospect Ave
Wfan BLDG Pc218
Hackensack, NJ 07601
Phone
(551) 996-5362
Fax
(551) 996-3232
NPI assigned
Jun 11, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2022

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 4123 CT
Physician Assistant 363A00000X 25MP00724200 NJ Primary

Addresses

Primary practice location

30 Prospect Ave
Wfan BLDG Pc218
Hackensack, NJ 07601

Mailing address

21 Laurelwood Dr
Mountain Lakes, NJ 07046-1732
Phone (973) 476-2909

Other practice location 1

24 Hospital Ave
Danbury, CT 06810
Phone (203) 739-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, NJ2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20180809001167 CT Practitioner - Physician Assistant 9931457835 Reassigns benefits to 1 organization
I20230802001308 NJ Practitioner - Physician Assistant 9931457835 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MP00724200NJMDPhysician Assistant
4123CTMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Hackensack Meridian Health Medical Group - Specialty Care PC CurrentSince Apr 20, 2023 Accepting new patients
Connecticut Children'S Specialty Group, Inc. Physician Assistant CurrentSince Sep 1, 2018 Accepting new patients
Hackensack Meridian Health Medical Group - Complex Care PC PastSince Oct 30, 2022 Accepting new patients

Locations

24 Hospital Ave
Danbury, CT 06810
Phone (203) 739-7118

10 Columbus Blvd
Hartford, CT 06106
Phone (860) 837-5619

282 Washington St
Hartford, CT 06106
Phone (860) 545-8950

10 Columbus Blvd
Fl 4
Hartford, CT 06106
Phone (860) 837-5560

30 Prospect Ave
Hackensack, NJ 07601
Phone (201) 488-0066

30 Prospect Ave
Bldg PC218
Hackensack, NJ 07601
Phone (551) 996-5362

Interoperability endpoints

  • Direct secure messaging: lsmith41388@connecticutchildrens.direct-ci.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/IHJHBD

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1528675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670284800000",
    "number": "1952894339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 LAURELWOOD DR",
            "city": "MOUNTAIN LAKES",
            "state": "NJ",
            "postal_code": "070461732",
            "telephone_number": "973-476-2909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 PROSPECT AVE",
            "address_2": "WFAN BLDG PC218",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "07601",
            "telephone_number": "551-996-5362",
            "fax_number": "551-996-3232"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "24 Hospital Ave",
            "address_purpose": "LOCATION",
            "city": "Danbury",
            "state": "CT",
            "postal_code": "06810",
            "country_code": "US",
            "telephone_number": "203-739-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "LAUREN",
        "middle_name": "KENDALL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-11",
        "last_updated": "2022-12-06",
        "certification_date": "2022-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "4123",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00724200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hackensack, NJ

Sources for this page

Verify at the official NPI Registry.