Active NPI
Mark L. Smucker, M.D.
- Cardiovascular Disease Physician
- Goshen, IN
National Provider Identifier
1528062932
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- 01036688A
- Practice address
- 1855 S Main St Ste a
Goshen, IN 46526-4845 - Phone
- (574) 533-7476
- Fax
- (574) 533-7145
- NPI assigned
- Jun 13, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | 01036688A | IN | Primary |
| Interventional Cardiology Physician | 207RI0011X | 01036688A | IN |
Addresses
Primary practice location
1855 S Main St Ste a
Goshen, IN 46526-4845
Mailing address
1855 S Main St Ste a
Goshen, IN 46526-4845
Phone (574) 533-7476
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100327940 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01036688A | IN | MD | Interventional Cardiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Memorial Hospital of South Bend | Past | Accepting new patients |
Interoperability endpoints
- mark.smucker.1@18573.direct.athenahealth.com
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.
-
- General Acute Care Hospital
- South Bend, IN
- NPI 1295772093
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1391558400000",
"number": "1528062932",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1855 S MAIN ST STE A",
"city": "GOSHEN",
"state": "IN",
"postal_code": "465264845",
"telephone_number": "574-533-7476",
"fax_number": "574-533-7145"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1855 S MAIN ST STE A",
"city": "GOSHEN",
"state": "IN",
"postal_code": "465264845",
"telephone_number": "574-533-7476",
"fax_number": "574-533-7145"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMUCKER",
"first_name": "MARK",
"middle_name": "L.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-13",
"last_updated": "2014-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "IN",
"license": "01036688A",
"primary": true
},
{
"code": "207RI0011X",
"taxonomy_group": "",
"desc": "Internal Medicine, Interventional Cardiology",
"state": "IN",
"license": "01036688A",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100327940",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Goshen, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.