DR. NICOLE LYNN SMITH (PSY.D., L.P.) – Clinical Child & Adolescent Psychologist, NPI 1215206552
Clinical Child & Adolescent Psychologist
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for DR. NICOLE LYNN SMITH (PSY.D., L.P.)
2841 BRYANT AVE S APT 130
MINNEAPOLIS, MN 554084896
Phone: (414) 232-7277
Type: Mailing
10273 YELLOW CIRCLE DR
MINNETONKA, MN 553439144
Phone: (952) 215-3759
Fax: (952) 401-9805
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-03-20
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 3 Medicare enrollment records; no due dates published yet.
Enrollment records
3
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20250318003343 | I | Clinical Psychologist | MN | TBD |
| I20250319002753 | I | Clinical Psychologist | NY | TBD |
| I20250320000957 | I | Clinical Psychologist | WI | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 55408)
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