Individual provider Active NPI

C. Michael Smith, MD

  • Family Medicine Physician
  • Temecula, CA
National Provider Identifier
1346306800
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
C140121 Issued in CA
Practice address
28961 Savannah Dr
Temecula, CA 92591-7572
Phone
(386) 290-6479
NPI assigned
Dec 29, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X C140121 CA Primary

Addresses

Primary practice location

28961 Savannah Dr
Temecula, CA 92591-7572

Mailing address

303 N Clyde Morris Blvd
Daytona Beach, FL 32114-2709
Phone (386) 254-4000

Other identifiers 2

IdentifierTypeStateIssuer
ME97255OtherFLMEDICAL LICENSE
536809851AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20160216001745 CA Practitioner - Emergency Medicine 8224122130 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Albany Medical College of Union University, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2601 E Chapman Ave
Orange, CA 92869-3206
Phone (714) 633-0011

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C140121CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Seven Star Hospital Associates Inc. CurrentSince Apr 1, 2021 Accepting new patients
Seven Star Hospital Associates Inc. CurrentSince Apr 1, 2021 Accepting new patients
Advanced Pediatric Specialists LLC Past Accepting new patients

Locations

1117 E Devonshire Ave
Hemet, CA 92543
Phone (951) 652-2811

2601 E Chapman Ave
Orange, CA 92869
Phone (714) 633-0011

2701 S Bristol St
Santa Ana, CA 92704
Phone (714) 636-0342

15248 Eleventh St
Victorville, CA 92395
Phone (760) 245-8691

Organizations & group practices 4

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 3

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": "1167350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1346306800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 N CLYDE MORRIS BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142709",
            "telephone_number": "386-254-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28961 SAVANNAH DR",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925917572",
            "telephone_number": "386-290-6479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "C. MICHAEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-29",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "C140121",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "ME97255",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "536809851A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Temecula, CA

Sources for this page

Verify at the official NPI Registry.