NPIMap

Individual provider Active NPI

Elton Travis Smith Jr., MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Charlotte, NC
National Provider Identifier
1487653416
Registry record updated Nov 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
9401109 Issued in NC
Practice address
10628 Park Rd
Charlotte, NC 28210-8407
Phone
(704) 973-5500
NPI assigned
Jul 20, 2005
Last updated
Nov 19, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology (Pathology) Physician 207ZH0000X 9401109 NC
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 9401109 NC Primary

Addresses

Primary practice location

10628 Park Rd
Charlotte, NC 28210-8407

Mailing address

PO Box 96782
Charlotte, NC 28296-6782
Phone (704) 973-5500

Other identifiers 4

IdentifierTypeStateIssuer
184945MedicaidSC
18494OtherSCSTATE MEDICAL BOARD
5904987MedicaidNC
9401109OtherNCSTATE MEDICAL BOARD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, SC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20060720000407 NC Practitioner - Pathology 4789697566 Reassigns benefits to 1 organization
I20110825000610 SC Practitioner - PathologyPractitioner - Dermatology 4789697566 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
PathologyAlso: Dermatology
Education
University of North Carolina at Chapel Hill School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolinas Pathology Group PAGroup PAC ID 3375529985, 50 clinicians

Practice addresses (Care Compare)

101 E Wood St
Spartanburg, SC 29303-3040
Phone (864) 560-6212

2001 Vail Ave
Charlotte, NC 28207-1219
Phone (704) 304-5988

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9401109NCMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Pathology Group, PA CurrentSince Sep 1, 2006 Accepting new patients
Carolinas Pathology Group, PA Anatomic Pathology & Clinical Pathology CurrentSince Nov 24, 2024 Accepting new patients
Pathology Associates Services, Inc Past Accepting new patients

Locations

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

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

10628 Park Rd
Charlotte, NC 28210
Phone (704) 543-2000

2001 Vail Ave
Charlotte, NC 28207
Phone (704) 304-5000

5040 Airport Center Pkwy
Charlotte, NC 28208
Phone (704) 446-4490

6135 Lakeview Rd
Ste 350
Charlotte, NC 28269
Phone (704) 549-8444

180 Parkwood Dr
Elkin, NC 28621
Phone (336) 527-7000

706 W King St
Kings Mtn, NC 28086
Phone (704) 730-5108

500 Lauchwood Dr
Laurinburg, NC 28352
Phone (856) 848-3227

433 McAlister Rd
Lincolnton, NC 28092
Phone (704) 512-7000

1000 Healing Way
Matthews, NC 28104
Phone (800) 821-1535

600 Hospital Dr
Monroe, NC 28112
Phone (704) 283-3100

201 E Grover St
Shelby, NC 28150
Phone (704) 487-3000

2301 US Highway 74 W
Wadesboro, NC 28170
Phone (704) 694-5131

1530 N Limestone St
Gaffney, SC 29340
Phone (864) 487-1544

250 Westmoreland Rd
Greer, SC 29651
Phone (864) 530-2108

101 E Wood St
Spartanburg, SC 29303
Phone (864) 560-1915

1700 Skylyn Dr
Spartanburg, SC 29307
Phone (864) 573-3123

389 Serpentine Dr
Spartanburg, SC 29303
Phone (864) 560-3263

1201 Furman L Fendley Hwy
Union, SC 29379
Phone (864) 301-2000

Interoperability endpoints

  • Direct secure messaging: esmith500153@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

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": "1121817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1487653416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 96782",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282966782",
            "telephone_number": "704-973-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10628 PARK RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282108407",
            "telephone_number": "704-973-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "ELTON",
        "middle_name": "TRAVIS",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-20",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZH0000X",
            "taxonomy_group": "",
            "desc": "Pathology, Hematology",
            "state": "NC",
            "license": "9401109",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NC",
            "license": "9401109",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "184945",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL BOARD",
            "identifier": "18494",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5904987",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL BOARD",
            "identifier": "9401109",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.