NPIMap

Individual provider Active NPI

Caleb Warner Smith, PA-C

  • Physician Assistant
  • Fayetteville, NC
National Provider Identifier
1164159471
Registry record updated Aug 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
001012309 Issued in NC
Practice address
1880 Quiet CV
Fayetteville, NC 28304-3857
Phone
(910) 323-2477
NPI assigned
Aug 5, 2022
Last updated
Aug 5, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 001012309 NC Primary

Addresses

Primary practice location

1880 Quiet CV
Fayetteville, NC 28304-3857

Mailing address

2041 Valleygate Dr Ste 101
Fayetteville, NC 28304-3746
Phone (910) 323-5203

Other practice location 1

2041 Valleygate Dr Ste 101
Fayetteville, NC 28304-3746
Phone (910) 323-5203

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20240912003882 NC Practitioner - Physician Assistant 8325588684 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolinas Physicians Network IncGroup PAC ID 3375449655, 2,324 clinicians

Practice addresses (Care Compare)

1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone (704) 355-2000

433 McAlister Rd
Lincolnton, NC 28092-4147
Phone (980) 212-2000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
001012309NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Aug 12, 2024 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Aug 12, 2024 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Aug 12, 2024 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Aug 12, 2024 Accepting new patients
Premier Gastroenterology, PA Past Accepting new patients

Locations

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

Interoperability endpoints

  • Direct secure messaging: csmith816103@carolinashealthcaresystem.direct-ci.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/EHJBAA

Organizations & group practices 7

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 7

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": "1659657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659657600000",
    "number": "1164159471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2041 VALLEYGATE DR STE 101",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043746",
            "telephone_number": "910-323-5203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1880 QUIET CV",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043857",
            "telephone_number": "910-323-2477"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2041 Valleygate Dr Ste 101",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "NC",
            "postal_code": "283043746",
            "country_code": "US",
            "telephone_number": "910-323-5203",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "CALEB",
        "middle_name": "WARNER",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-05",
        "last_updated": "2022-08-05",
        "certification_date": "2022-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "001012309",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.