Clarisa Idalia Smith, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

35537 Issued in AZ

Practice address

3001 Main St
Suite 1C
Prescott Valley, AZ 86314-2284

Phone

(928) 458-5470

Fax

(928) 458-5979

NPI assigned

Nov 9, 2006

Sex

Female

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 1

Medicare fee-for-service enrollment

Enrolled in AZ

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

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 and National Provider Directory roles.

• Yavapai Community Hospital Association

  dba Yavapai Regional Medical Center

  • General Acute Care Hospital
  • Prescott, AZ
  • NPI 1902897820
  NPD (past)

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592265600000",
    "number": "1699845180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 MAIN ST",
            "address_2": "SUITE 1C",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863142284",
            "telephone_number": "928-458-5470",
            "fax_number": "928-458-5979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 MAIN ST",
            "address_2": "SUITE 1C",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863142284",
            "telephone_number": "928-458-5470",
            "fax_number": "928-458-5979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "CLARISA",
        "middle_name": "IDALIA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-09",
        "last_updated": "2020-06-16",
        "certification_date": "2020-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "35537",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "624951",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tracey Small, MFT INTERN
• Kelli L Smart, PSYCHOLOGIST
• Smi Imaging, LLC
• Toni Smith Burgos, RPH
• Smith Valley Vision LLC
• Jack Smith, PHARMD
• Malorie Jo Smith, MS, LPC
• Nancy Renee Smith
• Paul Brian Smith, RPH
• Shelly Smith

• Pediatrics Physician in Prescott Valley, AZ
• Providers in Prescott Valley, AZ by specialty
• Pediatrics Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2020; 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.