Sam P Smith, D.O.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

4237 Issued in AZ

Practice address

4915 East Baseline Road
Suite 102
Gilbert, AZ 85234-2966

Phone

(480) 646-8660

Fax

(480) 646-8665

NPI assigned

Jul 17, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AZ

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

Specialty

Dermatology

Education

Lake Erie College of Osteopathic Medicine, Erie, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sam P Smith DO LLCGroup PAC ID 3870599426, 2 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Sam P Smith DO LLC

  • Dermatology Physician
  • Gilbert, AZ
  • NPI 1710904636
  Medicare reassignment Care Compare group NPD Authorized official
• Center for Dermatology, PLLC

  • Medical Physician Assistant
  • Scottsdale, AZ
  • NPI 1174062673
  NPD (past)

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376611200000",
    "number": "1962420315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4915 EAST BASELINE ROAD",
            "address_2": "SUITE 102",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342966",
            "telephone_number": "480-646-8660",
            "fax_number": "480-646-8665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4915 EAST BASELINE ROAD",
            "address_2": "SUITE 102",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342966",
            "telephone_number": "480-646-8660",
            "fax_number": "480-646-8665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "SAM",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2013-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "AZ",
            "license": "4237",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11458639",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117012",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maricela Michelle Smith, PSY.D.
• Michael L. Smith, M.D
• Millian Smith
• Nicholas Smith, APRN
• Sabrina Smith
• Skyler Jay Smith, DMD
• Stacy Smith, RD
• Steven Bryant Smith, BS, LISAC
• Tia Smith, RBT
• Tyler Smith

• Dermatology Physician in Gilbert, AZ
• Providers in Gilbert, AZ by specialty
• Dermatology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2013; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.