Malcolm Derek Smith, DPM PC

Primary specialty

PodiatristTaxonomy code 213E00000X

License

198 Issued in OK

Legal business name

MALCOLM DEREK SMITH, DPM PC

Practice address

1700 N 5TH St
Ponca City, OK 74601-2762

Phone

(580) 765-3389

Fax

(580) 762-3994

NPI assigned

Feb 26, 2008

Last updated

Feb 26, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jennifer Rae Smith

Title

Office Manager

Phone

(580) 765-3389

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OK2 enrollments

Enrollment records 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Malcolm Derek Smith, DPM

  • Podiatrist
  • Ponca City, OK
  • NPI 1093732562
  Medicare reassignment NPD
• Timothy R Blanton, DC

  • Chiropractor
  • Ponca City, OK
  • NPI 1821175076
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1203984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203984000000",
    "number": "1285803049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 N 5TH ST",
            "city": "PONCA CITY",
            "state": "OK",
            "postal_code": "746012762",
            "telephone_number": "580-765-3389",
            "fax_number": "580-762-3994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 N 5TH ST",
            "city": "PONCA CITY",
            "state": "OK",
            "postal_code": "746012762",
            "telephone_number": "580-765-3389",
            "fax_number": "580-762-3994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALCOLM DEREK SMITH, DPM PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-26",
        "last_updated": "2008-02-26",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "RAE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "580-765-3389"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "OK",
            "license": "198",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100779800A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "294540038001",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cristi Lea Luis, RN
• Jeffrey Luker
• Shelli Magin, LPC
• Sarah Renea Mahaffey-Pickup
• Brandi Wilcox Malaske, D.C.
• Steven Michael Mallory, LPC LADC
• Paige Rene Malone
• Tiffani Danielle Maloney-Gilbert
• Citabria Danielle Manly
• Amy Luree Marchesoni

• Podiatrist in Ponca City, OK
• Providers in Ponca City, OK by specialty
• Podiatrist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.