Active NPI
Charles T Smark Jr., M.D.
- Orthopaedic Surgery Physician
- Camp Pendleton, CA
National Provider Identifier
1104053271
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- 25855
- Practice address
- 200 Mercy Circle
Dept of Orthopedics
Camp Pendleton, CA 92055 - Phone
- (760) 725-1619
- NPI assigned
- Jun 16, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 25855 | NE | Primary |
Addresses
Primary practice location
200 Mercy Circle
Dept of Orthopedics
Camp Pendleton, CA 92055
Mailing address
200 Mercy Circle
Dept of Orthopedics
Camp Pendleton, CA 92055
Phone (760) 725-1619
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25855 | NE | MD | Nurse's Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245110400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661472000000",
"number": "1104053271",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 MERCY CIRCLE",
"address_2": "DEPT OF ORTHOPEDICS",
"city": "CAMP PENDLETON",
"state": "CA",
"postal_code": "92055",
"telephone_number": "760-725-1619"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 MERCY CIRCLE",
"address_2": "DEPT OF ORTHOPEDICS",
"city": "CAMP PENDLETON",
"state": "CA",
"postal_code": "92055",
"telephone_number": "760-725-1619"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMARK",
"first_name": "CHARLES",
"middle_name": "T",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-06-16",
"last_updated": "2022-08-26",
"certification_date": "2022-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "NE",
"license": "25855",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Camp Pendleton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.