David Allen Smith, M.D.

Primary specialty

Pediatric Surgery PhysicianTaxonomy code 2086S0120X

License

01040403A Issued in IN

Practice address

7613 W Jefferson Blvd Ste 200
Fort Wayne, IN 46804-4182

Phone

(260) 469-7337

Fax

(260) 469-7340

NPI assigned

May 23, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Great Lakes Pediatric Surgeons, Inc.

  • Pediatric Surgery Physician
  • Fort Wayne, IN
  • NPI 1669455267
  Medicare reassignment NPD Authorized official
• Indiana Surgical Specialists, LLC

  • Surgery Physician
  • Fort Wayne, IN
  • NPI 1528044625
  NPD (past)
• Parkview Hospital, Inc.

  • Trauma Surgery Physician
  • Fort Wayne, IN
  • NPI 1669576997
  NPD (past)

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1396224000000",
    "number": "1962405993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7613 W JEFFERSON BLVD STE 200",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044182",
            "telephone_number": "260-469-7337",
            "fax_number": "260-469-7340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7613 W JEFFERSON BLVD STE 200",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044182",
            "telephone_number": "260-469-7337",
            "fax_number": "260-469-7340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "DAVID",
        "middle_name": "ALLEN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-05-23",
        "last_updated": "2014-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IN",
            "license": "01040403A",
            "primary": false
        },
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "IN",
            "license": "01040403A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2080877",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104683309",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200049180",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charity Ann Smith
• Christina Ann Smith, PTA
• Corbett M Smith, MD
• Daniel Paul Smith, RPH
• Darryl Smith
• Dawn Ja'Ney Smith, LMHC-A
• Denise M Smith, DO
• Donald F Smith, ACSW, LCSW
• Elisabeth Smith
• Gregory Lee Smith, RPH

• Pediatric Surgery Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Pediatric Surgery Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.