Individual provider Active NPI

Malcolm Derek Smith, DPM

  • Podiatrist
  • Ponca City, OK
National Provider Identifier
1093732562
Registry record updated Sep 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
198 Issued in OK
Practice address
1700 N 5TH St
Ponca City, OK 74601-2762
Phone
(580) 765-3389
Fax
(580) 762-3994
NPI assigned
Jul 17, 2006
Last updated
Sep 29, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 198 OK Primary

Addresses

Primary practice location

1700 N 5TH St
Ponca City, OK 74601-2762

Mailing address

1700 N 5TH St
Ponca City, OK 74601-2762
Phone (580) 765-3389

Other identifiers 1

IdentifierTypeStateIssuer
100779800AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120228000786 OK Practitioner - Podiatry 8123096195 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
New York College of Podiatric Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1700 N 5TH St
Ponca City, OK 74601-2762
Phone (580) 765-3389

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
0

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue159
Removal of skin lesions1-10
Removal of nail tissue547
Removal or shaving of skin growth108
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
198OKMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Malcolm Derek Smith, DPM PC Podiatrist CurrentSince Jan 27, 2012 Accepting new patients

Locations

1700 N 5th St
Ponca City, OK 74601
Phone (580) 765-2482

Organizations & group practices 1

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 1

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": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790640000000",
    "number": "1093732562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 N 5TH ST",
            "city": "PONCA CITY",
            "state": "OK",
            "postal_code": "746012762",
            "telephone_number": "580-765-3389",
            "fax_number": "580-762-3994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 N 5TH ST",
            "city": "PONCA CITY",
            "state": "OK",
            "postal_code": "746012762",
            "telephone_number": "580-765-3389",
            "fax_number": "580-762-3994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MALCOLM",
        "middle_name": "DEREK",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2026-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "OK",
            "license": "198",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100779800A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponca City, OK

Sources for this page

Verify at the official NPI Registry.