Active NPI
Charles A Smallwood, M.D
- Occupational Medicine Physician
- KSC, FL
National Provider Identifier
1194945469
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Medicine Physician
- License
- 56366
- Practice address
- Omehs
CHS-005
KSC, FL 32899 - Phone
- (321) 861-8630
- Fax
- (321) 867-9360
- NPI assigned
- Apr 27, 2007
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Occupational Medicine Physician | 2083X0100X | 56366 | FL | Primary |
Addresses
Primary practice location
Omehs
CHS-005
KSC, FL 32899
Mailing address
56 Crystal River Dr
Cocoa Beach, FL 32931-2830
Phone (321) 799-9862
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 56366 | FL | MD | Occupational Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1194945469",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "56 CRYSTAL RIVER DR",
"city": "COCOA BEACH",
"state": "FL",
"postal_code": "329312830",
"telephone_number": "321-799-9862"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "OMEHS",
"address_2": "CHS-005",
"city": "KSC",
"state": "FL",
"postal_code": "32899",
"telephone_number": "321-861-8630",
"fax_number": "321-867-9360"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMALLWOOD",
"first_name": "CHARLES",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "M.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2083X0100X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Occupational Medicine",
"state": "FL",
"license": "56366",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.