NPIMap

Individual provider Active NPI

Justin Smith, M.D.

  • Student in an Organized Health Care Education/Training Program
  • Rome, GA
National Provider Identifier
1982015590
Registry record updated Feb 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
304 Shorter Ave NW Ste 201
Rome, GA 30165-4256
Phone
(706) 509-3358
Fax
(706) 292-7653
NPI assigned
May 16, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X GA Primary
Family Medicine Physician 207Q00000X 075250 GA

Addresses

Primary practice location

304 Shorter Ave NW Ste 201
Rome, GA 30165-4256

Mailing address

304 Shorter Ave NW Ste 201
Rome, GA 30165-4256
Phone (706) 509-3358

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20170518001652 MS Practitioner - Family Practice 4183929177 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Mississippi School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pontotoc Health Services, Inc.Group PAC ID 6002895356, 18 clinicians

Practice addresses (Care Compare)

400 Doctors Dr
New Albany, MS 38652-3109
Phone (662) 534-5036

Hospital & facility affiliations

  • North Mississippi Medical Ctr HHA Home health agency, Tupelo, MS, CCN 257002
  • Centerwell Home Health Home health agency, Tupelo, MS, CCN 257303
  • Baptist Home Care and Hospice North Mississippi Home health agency, Batesville, MS, CCN 257114
  • Pontotoc Health Service Inc Cah Hospital, Pontotoc, MS, CCN 251308
  • Baptist Memorial Hospital Union County Hospital, New Albany, MS, CCN 250006
  • North Mississippi Medical Center Hospital, Tupelo, MS, CCN 250004

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
075250GAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pontotoc Health Services, Inc. Current Accepting new patients
Pontotoc Health Services, Inc. CurrentSince Jun 25, 2017 Accepting new patients
Pontotoc Health Services, Inc. CurrentSince Jun 25, 2017 Accepting new patients
North Mississippi Medical Center Current Accepting new patients

Locations

202 Main St
Ecru, MS 38841
Phone (662) 489-4345

400 Doctors Dr
New Albany, MS 38652
Phone (662) 534-5036

345 Highway 15 N
Pontotoc, MS 38863
Phone (662) 489-7430

Interoperability endpoints

  • Direct secure messaging: justinsmith@nmhs.medalliesdirect.net

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.

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": "1400198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455667200000",
    "number": "1982015590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 SHORTER AVE NW STE 201",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301654256",
            "telephone_number": "706-509-3358",
            "fax_number": "706-292-7653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 SHORTER AVE NW STE 201",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301654256",
            "telephone_number": "706-509-3358",
            "fax_number": "706-292-7653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JUSTIN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-16",
        "last_updated": "2016-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "GA",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "075250",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rome, GA

Sources for this page

Verify at the official NPI Registry.