NPIMap

Organization Active NPI

David J. Smith MD PC

  • Family Medicine Physician
  • Grand Ledge, MI
National Provider Identifier
1669523650
Registry record updated Dec 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DS030055 Issued in MI
Legal business name
DAVID J. SMITH MD PC
Practice address
1035 Charlevoix Dr Ste 100
Grand Ledge, MI 48837-2223
Phone
(517) 627-2181
Fax
(517) 622-1242
NPI assigned
Jan 16, 2007
Last updated
Dec 11, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2017

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

Authorized official

Name
David J Smith, M.D.NPI 1275623662
Title
President
Phone
(517) 627-2181

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704208405 MI
Professional Counselor 101YP2500X 6401007475 MI
Family Medicine Physician 207Q00000X DS030055 MI Primary

Addresses

Primary practice location

1035 Charlevoix Dr Ste 100
Grand Ledge, MI 48837-2223

Mailing address

1035 Charlevoix Dr Ste 100
Grand Ledge, MI 48837-2223
Phone (517) 627-2181

Other identifiers 2

IdentifierTypeStateIssuer
080B360240OtherMIBCBSM GROUP NUMBER
C1769OtherMEDICARE RAILROAD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040925000140 MI Part B Supplier - Clinic/Group Practice 2567431729 Receives reassigned benefits from 21 practitioners
Practice locations: Grand Ledge, MI

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D0375592David J Smith MD1035 Charlevoix Drive, Suite 100, Grand Ledge, MI 48837Provider-performed microscopyFeb 1, 2028

National Provider Directory

National Provider Directory

Locations

11615 Hartel Rd
Ste 206
Grand Ledge, MI 48837
Phone (517) 347-3000

935 Charlevoix Dr
Ste 100
Grand Ledge, MI 48837
Phone (517) 372-2253

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512950400000",
    "number": "1669523650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1035 CHARLEVOIX DR STE 100",
            "city": "GRAND LEDGE",
            "state": "MI",
            "postal_code": "488372223",
            "telephone_number": "517-627-2181",
            "fax_number": "517-622-1242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1035 CHARLEVOIX DR STE 100",
            "city": "GRAND LEDGE",
            "state": "MI",
            "postal_code": "488372223",
            "telephone_number": "517-627-2181",
            "fax_number": "517-622-1242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID J. SMITH MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2017-12-11",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "517-627-2181",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704208405",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401007475",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "DS030055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM GROUP NUMBER",
            "identifier": "080B360240",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "C1769",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Ledge, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.