Active NPI
Terrence Edward Smith, M.D.
- Family Medicine Physician
- Clarksburg, CA
National Provider Identifier
1629152897
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- G 42590
- Practice address
- 52992 Sacramento Street
Box 69
Clarksburg, CA 95612-0069 - Phone
- (916) 744-1081
- NPI assigned
- Oct 24, 2006
- Last updated
- Jul 9, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | G 42590 | CA | Primary |
Addresses
Primary practice location
52992 Sacramento Street
Box 69
Clarksburg, CA 95612-0069
Mailing address
52992 Sacramento Street
Box 69
Clarksburg, CA 95612-0069
Phone (916) 744-1081
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G425900 | Medicaid | CA |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130314000507 | CA | Order and Referring Only - General Practice | 6507001856 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G 42590 | CA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1629152897",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "52992 SACRAMENTO STREET",
"address_2": "BOX 69",
"city": "CLARKSBURG",
"state": "CA",
"postal_code": "956120069",
"telephone_number": "916-744-1081"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "52992 SACRAMENTO STREET",
"address_2": "BOX 69",
"city": "CLARKSBURG",
"state": "CA",
"postal_code": "956120069",
"telephone_number": "916-744-1081"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "TERRENCE",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-24",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "G 42590",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G425900",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clarksburg, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.