Individual provider Active NPI

Charles Smith, MD

  • Family Medicine Physician
  • Flagstaff, AZ
National Provider Identifier
1053383950
Registry record updated Dec 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
28946 Issued in AZ
Practice address
107 E Oak Ave
Flagstaff, AZ 86001-1818
Phone
(928) 913-8800
Fax
(928) 913-8801
NPI assigned
Feb 3, 2006
Last updated
Dec 6, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 28946 AZ Primary

Addresses

Primary practice location

107 E Oak Ave
Flagstaff, AZ 86001-1818

Mailing address

1200 N Beaver St
Flagstaff, AZ 86001-3118
Phone (928) 213-6235

Other identifiers 1

IdentifierTypeStateIssuer
719536MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111222000252 AZ Practitioner - Family Practice 4789850728 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Albert Einstein College of Medicine of Yeshiva University, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1215 N Beaver St
Suite 203
Flagstaff, AZ 86001-3126
Phone (928) 773-2249

1895 N Jasper Dr
Flagstaff, AZ 86001-1632

2000 S Thompson St
Flagstaff, AZ 86001-8759
Phone (928) 226-6400

269 S Candy LN
Cottonwood, AZ 86326-4158
Phone (928) 639-6000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.13 of 100Reported as group
Quality
66.85
Promoting interoperability
99
Improvement activities
40
Cost
74.4

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
28946AZMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Country Healthcare, Inc. Current Accepting new patients
North Country Healthcare, Inc. CurrentSince Sep 9, 2002 Accepting new patients
Northern Arizona Healthcare Corporation CurrentSince Nov 1, 2024 Accepting new patients
Flagstaff Pathology Associates Current Accepting new patients
North Country Healthcare, Inc. Family Medicine Current Accepting new patients
Northern Arizona Healthcare Corporation Family Medicine CurrentSince Nov 1, 2024 Accepting new patients
North Country Healthcare, Inc. CurrentSince Sep 9, 2002 Accepting new patients
North Country Healthcare Inc Past Accepting new patients

Locations

2585 Miracle Mile
Ste 116
Bullhead City, AZ 86442
Phone (928) 219-3300

269 S Candy Ln
Cottonwood, AZ 86326
Phone (928) 634-2251

107 E Oak Ave
Flagstaff, AZ 86001
Phone (928) 779-7880

1120 W University Ave
Flagstaff, AZ 86001
Phone (928) 212-5761

1120 W University Ave
Ste 101
Flagstaff, AZ 86001
Phone (928) 522-1300

1200 N Beaver St
Flagstaff, AZ 86001
Phone (928) 213-6235

1215 N Beaver St
Ste 203
Flagstaff, AZ 86001
Phone (928) 773-2249

1895 N Jasper Dr
Ste 3
Flagstaff, AZ 86001
Phone (928) 213-6385

2187 N Vickey St
Ste 2
Flagstaff, AZ 86004
Phone (928) 527-1899

2500 N Rose St
Flagstaff, AZ 86004
Phone (928) 213-6121

2920 N 4th St
Flagstaff, AZ 86004
Phone (928) 213-6100

2109 Navajo Blvd
Holbrook, AZ 86025
Phone (928) 213-6100

1510 N Stockton Hill Rd
Kingman, AZ 86401
Phone (928) 753-1177

2090 Smoketree Ave N
Lk Havasu Cty, AZ 86403
Phone (928) 854-1800

2650 E Show Low Lake Rd
Ste 1
Show Low, AZ 85901
Phone (928) 537-4300

488 S Mountain Ave
Springerville, AZ 85938
Phone (928) 333-0127

300 S 6th St
Williams, AZ 86046
Phone (928) 635-4441

620 Lee St
Winslow, AZ 86047
Phone (928) 288-8700

Organizations & group practices 8

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1138924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733443200000",
    "number": "1053383950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 N BEAVER ST",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860013118",
            "telephone_number": "928-213-6235",
            "fax_number": "928-213-6292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 E OAK AVE",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860011818",
            "telephone_number": "928-913-8800",
            "fax_number": "928-913-8801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "CHARLES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-03",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "28946",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "719536",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flagstaff, AZ

Sources for this page

Verify at the official NPI Registry.