Mark Samuel Smith, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110004485 Issued in VA

Practice address

16000 Johnston Memorial Dr
Fourth Floor
Abingdon, VA 24211-7659

Phone

(276) 258-4050

Fax

(276) 258-4056

NPI assigned

Oct 23, 2012

Last updated

Feb 23, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Lincoln Memorial University Medical Department, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southeastern Intensivist Services PCGroup PAC ID 9335152107, 234 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wythe County Community Hospital Hospital, Wytheville, VA, CCN 490111

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Southeastern Intensivist Services PC

  • Hospitalist Physician
  • West Memphis, AR
  • NPI 1912942665

  VA

  Medicare reassignment Care Compare group
• Southeastern Medical Group, PC

  • Hospitalist Physician
  • Brevard, NC
  • NPI 1184669053

  VA

  Medicare reassignment
• Blue Ridge Medical Management Corporation

  dba Ballad Health Medical Associates

  • Hospitalist Physician
  • Abingdon, VA
  • NPI 1104171826

  Physician Assistant

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Wythe County Community Hospital LLC

  dba Wythe County Community Hospital

  • Rural Acute Care Hospital
  • Wytheville, VA
  • NPI 1184706152
  Care Compare affiliation

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

{
    "created_epoch": "1350950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487808000000",
    "number": "1629321021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16000 JOHNSTON MEMORIAL DR",
            "address_2": "FOURTH FLOOR",
            "city": "ABINGDON",
            "state": "VA",
            "postal_code": "242117659",
            "telephone_number": "276-258-4050",
            "fax_number": "276-258-4056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16000 JOHNSTON MEMORIAL DR",
            "address_2": "FOURTH FLOOR",
            "city": "ABINGDON",
            "state": "VA",
            "postal_code": "242117659",
            "telephone_number": "276-258-4050",
            "fax_number": "276-258-4056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MARK",
        "middle_name": "SAMUEL",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-10-23",
        "last_updated": "2017-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "2210",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110004485",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01334893",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q000164",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1629321021",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Hunt Smith, MD
• Happy E Smith, MD
• Hunter C Smith, DDS
• Jessica Ann Smith, DNAP
• Keri Nicole Smith, FNP-C
• Robin Smith
• Sydni Kaylyn Smith, MSW
• Damian Sooklal, MD
• Soulstice Nutrition LLC
• Southeastern Mobile Dental Services Inc

• Physician Assistant in Abingdon, VA
• Providers in Abingdon, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2017; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.