NPIMap

Individual provider Active NPI

Elysia Smith, DO

  • Emergency Medicine Physician
  • Morrisville, NC
National Provider Identifier
1871889170
Registry record updated May 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
2015-01646 Issued in NC
Practice address
3000 Aerial Center Pkwy Ste 130
Morrisville, NC 27560-0077
Phone
(919) 461-7131
NPI assigned
Jun 24, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 2015-01646 NC Primary

Addresses

Primary practice location

3000 Aerial Center Pkwy Ste 130
Morrisville, NC 27560-0077

Mailing address

1124 Wakefield Farm Rd
Zebulon, NC 27597-7353
Phone (972) 768-0129

Other practice location 1

101 Dudley St
Providence, RI 02905-2401
Phone (401) 274-1122

Other names 1

  • Elysia Mallon Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151112001950 NC Practitioner - Emergency Medicine 3375853831 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Lake Erie College of Osteopathic Medicine, Erie, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cfvhs Ed PhysiciansGroup PAC ID 2961316237, 27 clinicians

Practice addresses (Care Compare)

1638 Owen Dr
Fayetteville, NC 28304-3424
Phone (910) 615-8780

Hospital & facility affiliations

  • Cape Fear Valley Medical Center Hospital, Fayetteville, NC, CCN 340028
  • Cape Fear Valley-Bladen County Hospital Hospital, Elizabethtown, NC, CCN 341315

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
2015-01646NCMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cfvhs Ed Physicians Emergency Medicine CurrentSince Jan 1, 2021 Accepting new patients
Emergency Coverage, LLC Emergency Medicine CurrentSince Sep 1, 2015 Accepting new patients
Wilson Emergency Physician Partners PLLC Emergency Medicine CurrentSince Jun 1, 2019 Accepting new patients
Gem Capital Physicians, PLLC Emergency Medicine CurrentSince Mar 2, 2019 Accepting new patients
Bull City Physicians, PLLC Emergency Medicine CurrentSince Mar 1, 2019 Accepting new patients
Cfvhs Ed Physicians Emergency Medicine Current Accepting new patients
Emergency Coverage Services, PC Past Accepting new patients

Locations

501 S Poplar St
Elizabethtown, NC 28337
Phone (910) 862-4043

1638 Owen Dr
Fayetteville, NC 28304
Phone (910) 609-5610

566 Ruin Creek Rd
Henderson, NC 27536
Phone (252) 436-1352

100 Hospital Dr
Louisburg, NC 27549
Phone (252) 438-4143

615 Ridge Rd
Roxboro, NC 27573
Phone (336) 503-5699

1705 Tarboro St SW
Wilson, NC 27893
Phone (252) 399-8040

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

Organizations & group practices 7

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.

Hospital & facility affiliations 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1308873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589932800000",
    "number": "1871889170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1124 WAKEFIELD FARM RD",
            "city": "ZEBULON",
            "state": "NC",
            "postal_code": "275977353",
            "telephone_number": "972-768-0129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 AERIAL CENTER PKWY STE 130",
            "city": "MORRISVILLE",
            "state": "NC",
            "postal_code": "275600077",
            "telephone_number": "919-461-7131"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 Dudley St",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029052401",
            "country_code": "US",
            "telephone_number": "401-274-1122",
            "fax_number": "401-453-7597",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "ELYSIA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-24",
        "last_updated": "2020-05-20",
        "certification_date": "2020-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "2015-01646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELYSIA",
            "last_name": "MALLON",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Morrisville, NC

Sources for this page

Verify at the official NPI Registry.