NPIMap

Individual provider Active NPI

Clark Charles Smith, M.D.

  • Physical Medicine & Rehabilitation Physician
  • New York, NY
National Provider Identifier
1043494800
Registry record updated Jul 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
260227 Issued in NY
Practice address
180 Fort Washington Ave
Suite 199
New York, NY 10032-3722
Phone
(212) 305-3535
Fax
(212) 342-1470
NPI assigned
Dec 28, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 260227 NY Primary
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X 260227 NY

Addresses

Primary practice location

180 Fort Washington Ave
Suite 199
New York, NY 10032-3722

Mailing address

180 Fort Washington Ave
Suite 199
New York, NY 10032-3722
Phone (212) 305-3535

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20110615000090 NY Practitioner - Physical Medicine and RehabilitationPractitioner - Internal Medicine 3173700473 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Tulane University School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Trustees of Columbia University in the City of New YorkGroup PAC ID 8527972546, shared by 10 NPIs, 2,262 clinicians

Practice addresses (Care Compare)

622 W 168TH St
New York, NY 10032-3720

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
85.32
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Trustees of Columbia University in the City of New York CurrentSince Aug 1, 2016 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Aug 1, 2016 Accepting new patients
Trustees of Columbia University in the City of New York Physical Medicine & Rehabilitation CurrentSince Jan 1, 2018 Accepting new patients
Trustees of Columbia University in the Department of Otolaryngology Past Accepting new patients

Locations

161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559

180 Fort Washington Ave
Ste 199
New York, NY 10032
Phone (212) 305-3535

180 Fort Washington Ave
New York, NY 10032
Phone (212) 305-3535

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

180 Fort Washington Ave
#199
New York, NY 10032
Phone (212) 305-3535

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • Direct secure messaging: cls9020@direct.nyp.org
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

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 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1198800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406160000000",
    "number": "1043494800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 FORT WASHINGTON AVE",
            "address_2": "SUITE 199",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323722",
            "telephone_number": "212-305-3535",
            "fax_number": "212-342-1470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 FORT WASHINGTON AVE",
            "address_2": "SUITE 199",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323722",
            "telephone_number": "212-305-3535",
            "fax_number": "212-342-1470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "CLARK",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-12-28",
        "last_updated": "2014-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NY",
            "license": "260227",
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "NY",
            "license": "260227",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.