Mark Allan Smith, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A72221 Issued in CA

Practice address

243 Georgia Street
Ste B
Vallejo, CA 94590

Phone

(707) 556-8100

Fax

(707) 556-8107

NPI assigned

Sep 6, 2006

Last updated

May 30, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 8

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• La Clinica de la Raza Inc

  dba La Clinica Dental at Children's Hospital Oakland

  • Federally Qualified Health Center (FQHC)
  • Oakland, CA
  • NPI 1346262292
  NPD (past)
• La Clinica de la Raza Inc

  dba La Clinica Vallejo

  • Federally Qualified Health Center (FQHC)
  • Vallejo, CA
  • NPI 1992811392
  NPD (past)

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369872000000",
    "number": "1588767602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 ALHAMBRA AVE",
            "city": "MARTINEZ",
            "state": "CA",
            "postal_code": "945533156",
            "telephone_number": "925-427-8585",
            "fax_number": "925-427-8591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "243 GEORGIA STREET",
            "address_2": "STE B",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "94590",
            "telephone_number": "707-556-8100",
            "fax_number": "707-556-8107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MARK",
        "middle_name": "ALLAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-06",
        "last_updated": "2013-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A72221",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FQHC MEDICARE PART A",
            "identifier": "55-1975",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70543G",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FQHC MEDICARE PART B",
            "identifier": "ZZZ29799Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FQHC MEDICARE PART A",
            "identifier": "55-1915",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC71021F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FQHC MEDICARE PART B",
            "identifier": "ZZZ23222Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FPACT",
            "identifier": "HAP71021F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FPACT",
            "identifier": "HAP70543G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Antoinette Rochelle Smith
• Carla Smith, PSY.D.
• Christine Smith, NURSE PRACTITIONER
• Judith Gail Smith, NP
• Madeline Irene Smith, MD
• Richard Lyn Smith
• Robert Lee Smith III
• Sarah Anne Smith, D.O.
• Sha Vonn Smith
• Shannon Smith

• Family Medicine Physician in Vallejo, CA
• Providers in Vallejo, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.