NPIMap

Individual provider Active NPI

Deryan Smith

  • Emergency Medicine Physician
  • Charlotte, NC
National Provider Identifier
1407599780
Registry record updated Jun 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
2025-01209 Issued in NC
Practice address
1000 Blythe Blvd
Meb 3
Charlotte, NC 28203
Phone
(704) 355-2000
NPI assigned
Apr 15, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X 2025-01209 NC Primary

Addresses

Primary practice location

1000 Blythe Blvd
Meb 3
Charlotte, NC 28203

Mailing address

PO Box 32861
Charlotte, NC 28232-2861

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
I20250818001514 NC Practitioner - Emergency Medicine 6901274901 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Nevada School of Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Western Carolina Emergency Physicians, PLLCGroup PAC ID 8921171190, 14 clinicians
Wake Forest Emergency ProvidersGroup PAC ID 7012819816, 497 clinicians

Practice addresses (Care Compare)

301 Yadkin St
Albemarle, NC 28001-3441
Phone (704) 984-4000

920 Church St N
Concord, NC 28025-2927
Phone (704) 403-3000

Hospital & facility affiliations

  • Atrium Health Pineville Hospital, Charlotte, NC, CCN 340098
  • Carolinas Medical Center/Behav Health Hospital, Charlotte, NC, CCN 340113

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2025-01209NCMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gastonia Physician Services, PLLC Emergency Medicine CurrentSince Aug 1, 2025 Accepting new patients
Wake Forest Emergency Providers CurrentSince Jul 7, 2025 Accepting new patients
Western Carolina Emergency Physicians, PLLC Emergency Medicine CurrentSince Jun 1, 2025 Accepting new patients
Gastonia Physician Services, PLLC Emergency Medicine CurrentSince Aug 1, 2025 Accepting new patients

Locations

301 Yadkin St
Albemarle, NC 28001
Phone (704) 984-4000

1240 Huffman Mill Rd
Burlington, NC 27215
Phone (336) 538-7000

920 Church St N
Concord, NC 28025
Phone (704) 403-3000

2525 Court Dr
Gastonia, NC 28054
Phone (704) 834-2662

451 E Charlotte Ave
Mt Holly, NC 28120
Phone (980) 834-2266

Interoperability endpoints

  • Direct secure messaging: dsmith902721@carolinashealthcaresystem.direct-ci.com
  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

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 8

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": "1649980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750377600000",
    "number": "1407599780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 32861",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282322861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BLYTHE BLVD",
            "address_2": "MEB 3",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28203",
            "telephone_number": "704-355-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "DERYAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-15",
        "last_updated": "2025-06-20",
        "certification_date": "2025-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "2025-01209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.