Active NPI
John B. Smith Jr., MD
- Family Medicine Physician
- Clinton, NC
National Provider Identifier
1659309581
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 00-21870
- Practice address
- 403 Fairview St
Clinton, NC 28328-2399 - Phone
- (910) 592-6011
- Fax
- (910) 592-0817
- NPI assigned
- Jun 29, 2006
- Last updated
- Oct 18, 2019
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 00-21870 | NC | Primary |
Addresses
Primary practice location
403 Fairview St
Clinton, NC 28328-2399
Mailing address
403 Fairview St
Clinton, NC 28328-2311
Phone (910) 592-6011
Other practice location 1
404 Fairview St
Clinton, NC 28328-2312
Phone (910) 592-6011
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5807381 | Other | NC | AETNA |
| 77854 | Other | NC | NC BLUE CROSS BLUE SHIELD |
| 0138819 | Other | NC | UNITED HEALTHCARE |
| 30927 | Other | NC | MEDCOST |
| 560955090F | Other | NC | CIGNA |
| 00369135 | Medicaid | NC |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | clintonmedicalclinic@cmci.allscriptsdirect.net | Direct | |
| Direct Messaging Address | johnsmith@cmci.allscriptsdirect.net | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21870 | NC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571356800000",
"number": "1659309581",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "403 FAIRVIEW ST",
"city": "CLINTON",
"state": "NC",
"postal_code": "283282311",
"telephone_number": "910-592-6011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "403 FAIRVIEW ST",
"city": "CLINTON",
"state": "NC",
"postal_code": "283282399",
"telephone_number": "910-592-6011",
"fax_number": "910-592-0817"
}
],
"practiceLocations": [
{
"address_1": "404 Fairview St",
"address_purpose": "LOCATION",
"city": "Clinton",
"state": "NC",
"postal_code": "283282312",
"country_code": "US",
"telephone_number": "910-592-6011",
"fax_number": "910-592-0811",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SMITH",
"first_name": "JOHN",
"middle_name": "B.",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-29",
"last_updated": "2019-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NC",
"license": "00-21870",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "5807381",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NC BLUE CROSS BLUE SHIELD",
"identifier": "77854",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "0138819",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST",
"identifier": "30927",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "560955090F",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00369135",
"state": "NC"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "clintonmedicalclinic@cmci.allscriptsdirect.net",
"affiliation": "N",
"endpointDescription": "Direct Message",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Direct Message",
"address_1": "403 Fairview St",
"city": "Clinton",
"state": "NC",
"country_code": "US",
"postal_code": "283282399",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "johnsmith@cmci.allscriptsdirect.net",
"affiliation": "N",
"endpointDescription": "direct Message",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Direct Message",
"address_1": "403 Fairview St",
"city": "Clinton",
"state": "NC",
"country_code": "US",
"postal_code": "283282399",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Clinton, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2019; 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.