Mark Smith, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

133975 Issued in CA

Practice address

1057 E Grand Ave
Arroyo Grande, CA 93420-2504

Phone

(805) 270-1700

Fax

(805) 481-7097

NPI assigned

Jul 12, 2010

Last updated

Aug 7, 2015By 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

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Dr Mona Shah Professional CorporationGroup PAC ID 2062548084, 11 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Little Co of Mary Med Ctr San Pedro Hospital, San Pedro, CA, CCN 050078

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Dr Mona Shah Professional Corporation

  • Internal Medicine Physician
  • San Pedro, CA
  • NPI 1053643171
  Medicare reassignment Care Compare group NPD
• Community Health Centers of the Central Coast Inc

  • Federally Qualified Health Center (FQHC)
  • Oceano, CA
  • NPI 1336166248
  Medicare reassignment NPD
• Community Health Centers of the Central Coast Inc

  • Federally Qualified Health Center (FQHC)
  • San Luis Obispo, CA
  • NPI 1275553257
  NPD
• Community Health Centers of the Central Coast Inc

  • Federally Qualified Health Center (FQHC)
  • Santa Maria, CA
  • NPI 1447277355
  NPD
• Community Health Centers of the Central Coast Inc

  dba Community Health Centers Cambria

  • Federally Qualified Health Center (FQHC)
  • Cambria, CA
  • NPI 1881611705
  NPD
• Zeljko Zic M.D. Inc.

  • Endocrinology, Diabetes & Metabolism Physician
  • San Pedro, CA
  • NPI 1740200526
  NPD (past)

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

• Providence Health System - Southern California

  dba Providence Little Company of Mary Medical Center San Pedro OBHC

  • General Acute Care Hospital
  • San Pedro, CA
  • NPI 1497241541
  Care Compare affiliation
• Providence Health System - Southern California

  dba Providence Little Company of Mary Medical Center San Pedro

  • General Acute Care Hospital
  • San Pedro, CA
  • NPI 1942247291
  Care Compare affiliation

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

{
    "created_epoch": "1278892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438905600000",
    "number": "1780996371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050S BLOSSER RD",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934587310",
            "telephone_number": "805-361-8028",
            "fax_number": "805-361-8097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1057 E GRAND AVE",
            "city": "ARROYO GRANDE",
            "state": "CA",
            "postal_code": "934202504",
            "telephone_number": "805-270-1700",
            "fax_number": "805-481-7097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-07-12",
        "last_updated": "2015-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "133975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beth S Simon, PHD
• Eric Peter Simon, PHD
• Slo County Drug & Alcohol Service
• Randy Dell Smart, O.D.
• Ronald L Smith-Arizmendi, M.D.
• Troy Anthony Smith, D.C.
• Eric Sparshott
• Kenneth A. Spearman, MD
• Garald Vincent Spelbring, RPH
• K. Juliet Sponsel, M.A.

• Family Medicine Physician in Arroyo Grande, CA
• Providers in Arroyo Grande, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2015; 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.