Charles Wilson Smith Jr., M.D.
Individual provider Active NPI Family Medicine Physician · Little Rock, AR
NPI 1154374932 · NPPES record last updated Nov 12, 2020
Key facts
- NPI
- 1154374932
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- R3995 (AR)
- Practice address
- 4301 W. Markham St
#783
Little Rock, AR 72205 - Phone
- (501) 686-8000
- NPI assigned
- May 19, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 14
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of North Carolina at Chapel Hill School of Medicine, 1974
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Access Medical Clinic Arkansas LTC LLC
University of Arkansas for Medical Sciences
Practice addresses (Care Compare)
1016 N Fourche Ave
Perryville, AR 72126-8545
Phone (501) 238-1284
4301 W Markam St
Little Rock, AR 72205-7101
Phone (501) 686-8000
Hospital & facility affiliations
- University of Arkansas Medical Sciences
- The Green House Cottages of Poplar Grove
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070508000545 | AR | Practitioner - Family Practice | 4082710066 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R3995 | AR | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Arkansas for Medical Sciences | Family Medicine | Current |
Accepting new patients |
| Access Medical Clinic Arkansas LTC LLC | Family Medicine | Current |
Accepting new patients |
| Access Medical Clinic Arkansas LTC LLC | Family Medicine | Current |
Accepting new patients |
| University of Arkansas for Medical Sciences | Family Medicine | Current |
Accepting new patients |
| Access Medical Clinic Arkansas LLC | Current |
Accepting new patients | |
| Access Medical Clinic Arkansas LLC | Family Medicine | Current |
Accepting new patients |
Locations
16723 Highway 62
Garfield, AR 72732
Phone (870) 219-7706
4301 W Markham St
#783
Little Rock, AR 72205
Phone (501) 603-1278
4301 W Markham St
Little Rock, AR 72205
Phone (501) 603-1278
1016 N Fourche Ave
Perryville, AR 72126
Phone (501) 237-1284
106 N Van Buren St
Weiner, AR 72479
Phone (870) 605-0014
Interoperability endpoints
- charles.smith.1@29938.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R3995 | AR | Yes |
Addresses
Primary practice location
4301 W. Markham St
#783
Little Rock, AR 72205
Mailing address
4301 W Markham St # 783
Little Rock, AR 72205-7101
Phone (501) 686-8000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 116085001 | Medicaid | AR |
Other providers in Little Rock, AR
- Bryan Keith Smith
- Bryunna Smith
- Carey Smith
- Chandra Dione Smith
- Chanell Smith
- Chasney Smith
- Christopher Smith
- Christy Michelle Smith
- Clark Lander Smith
- Codi Elizabeth Smith
All providers in Little Rock, AR · Family Medicine Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 12, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.