Individual provider Active NPI

Michael Smith, M.D.

  • Otolaryngology Physician
  • Mattoon, IL
National Provider Identifier
1215043971
Registry record updated Nov 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
036-092274 Issued in IL
Practice address
1005 Health Center Dr Ste 201
Mattoon, IL 61938-4653
Phone
(217) 258-2409
Fax
(217) 258-2323
NPI assigned
Aug 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 036-092274 IL Primary

Addresses

Primary practice location

1005 Health Center Dr Ste 201
Mattoon, IL 61938-4653

Mailing address

PO Box 372
Mattoon, IL 61938-0372

Other practice location 1

905 N Maple St
Effingham, IL 62401-6401
Phone (217) 347-7077

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100216000537 IL Practitioner - Otolaryngology 2567506488 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Wake Forest University School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sarah Bush Lincoln Health CenterGroup PAC ID 5092614867, 411 clinicians

Practice addresses (Care Compare)

1000 Health Ctr Dr
Suite 201
Mattoon, IL 61938-4639
Phone (217) 258-4030

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.96 of 100Reported as apm
Quality
69.5
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036-092274ILMDOtolaryngology Physician

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 and National Provider Directory roles.

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": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731024000000",
    "number": "1215043971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 372",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619380372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 HEALTH CENTER DR STE 201",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619384653",
            "telephone_number": "217-258-2409",
            "fax_number": "217-258-2323"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "905 N Maple St",
            "address_purpose": "LOCATION",
            "city": "Effingham",
            "state": "IL",
            "postal_code": "624016401",
            "country_code": "US",
            "telephone_number": "217-347-7077",
            "fax_number": "217-347-7197",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MICHAEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2024-11-08",
        "certification_date": "2024-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IL",
            "license": "036-092274",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mattoon, IL

Sources for this page

Verify at the official NPI Registry.