Preston S Smith, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA464 Issued in ID

Practice address

215 E Hawaii Ave
Nampa, ID 83686-6011

Phone

(208) 468-5930

Fax

(208) 463-3044

NPI assigned

Oct 21, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 6

Other names 1

• Scott Smith Professional name

Medicare fee-for-service enrollment

Enrolled in ID

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 1

Specialty

Physician Assistant

Education

Other, 2003

Medicare assignment

May accept Medicare assignment

Group practices

Ada Dermatology P aGroup PAC ID 5395833586, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: psmith23746@direct.slhs.org

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.

• Ada Dermatology, P.a.

  • Procedural Dermatology Physician
  • Boise, ID
  • NPI 1952483299
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1129852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698796800000",
    "number": "1992794929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 E HAWAII AVE",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836866011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 E HAWAII AVE",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836866011",
            "telephone_number": "208-468-5930",
            "fax_number": "208-463-3044"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 W. Fort St.",
            "address_2": "# 111",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "83702",
            "country_code": "US",
            "telephone_number": "208-422-1000",
            "fax_number": "208-422-1319",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "PRESTON",
        "middle_name": "S",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-21",
        "last_updated": "2023-11-01",
        "certification_date": "2023-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA464",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010145450",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "DAGV3",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010145449",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806749400",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "PAG001",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00160006",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SCOTT",
            "last_name": "SMITH",
            "credential": "PA-C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Melanie Eileen Smith, RN
• Melissa Smith, MD
• Melissa Myers Smith, LPC
• Mitchell Thomas Smith, MS, LPC
• Nichole Leann Smith, CPT
• Quinn J Smith, DMD
• Samantha Lakey Smith, DPT
• Sydney Cascade Smith, LMT
• Taylor Daisy Smith
• Alicia Smylie, L.M.T.

• Physician Assistant in Nampa, ID
• Providers in Nampa, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2023; 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.