Provider Demographics
NPI:1780649301
Name:SMITH, JASON A (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 WILLIAM HOWARD TAFT RD
Mailing Address - Street 2:2ND FLOOR, CBO 2-3
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2610
Mailing Address - Country:US
Mailing Address - Phone:513-206-1800
Mailing Address - Fax:513-206-1834
Practice Address - Street 1:5885 HARRISON AVE
Practice Address - Street 2:SU. 1900
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-1691
Practice Address - Country:US
Practice Address - Phone:513-206-1800
Practice Address - Fax:513-206-1834
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059484A207RC0000X
OH35077759207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200224360Medicaid
283623OtherAMERIGROUP
KY64082027Medicaid
000000325353OtherANTHEM
7254586OtherAETNA
OH2461198Medicaid
000000325354OtherANTHEM MIDDLETOWN
77759-01OtherHUMANA
283623OtherAMERIGROUP
IN200224360Medicaid
IN200224360Medicaid
OH4125384Medicare PIN
OHSM4125386Medicare ID - Type UnspecifiedANDERSON