Active NPI
Lewis Kelley Smith, PA
- Physician Assistant
- Davie, FL
National Provider Identifier
1982273678
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 9114266
- Practice address
- 4301 S Flamingo Rd
Davie, FL 33330-1902 - Phone
- (954) 640-1200
- NPI assigned
- Jun 17, 2021
- Last updated
- Nov 6, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 9114266 | FL | Primary |
Addresses
Primary practice location
4301 S Flamingo Rd
Davie, FL 33330-1902
Mailing address
4301 S Flamingo Rd
Davie, FL 33330-1902
Phone (954) 640-1200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1581533056 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
4301 S Flamingo Rd
Davie, FL 33330-1902
Phone (954) 640-1200
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9114266 | FL | MD | Physician Assistant |
Organizations & group practices 2
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.
-
- Family Medicine Physician
- Davie, FL
- NPI 1992931018
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623888000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636156800000",
"number": "1982273678",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4301 S FLAMINGO RD",
"city": "DAVIE",
"state": "FL",
"postal_code": "333301902",
"telephone_number": "954-640-1200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4301 S FLAMINGO RD",
"city": "DAVIE",
"state": "FL",
"postal_code": "333301902",
"telephone_number": "954-640-1200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "LEWIS",
"middle_name": "KELLEY",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-06-17",
"last_updated": "2021-11-06",
"certification_date": "2021-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "9114266",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1581533056",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Davie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2021; 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.