Active NPI
Carolyn Marion Smith, M.D.
- Clinic/Center
- Bloomington, IN
National Provider Identifier
1962646786
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- License
- 01027170
- Practice address
- 3620 N Lauren LN
Bloomington, IN 47404-9206 - Phone
- (317) 697-7607
- Fax
- (317) 574-0050
- NPI assigned
- Apr 23, 2009
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | 01027170 | IN | Primary |
Addresses
Primary practice location
3620 N Lauren LN
Bloomington, IN 47404-9206
Mailing address
3620 N Lauren LN
Bloomington, IN 47404-9206
Phone (317) 697-7607
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01027170 | IN | MD | Clinic/Center |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1240444800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1240444800000",
"number": "1962646786",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3620 N LAUREN LN",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474049206",
"telephone_number": "317-697-7607",
"fax_number": "317-574-0050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3620 N LAUREN LN",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474049206",
"telephone_number": "317-697-7607",
"fax_number": "317-574-0050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "CAROLYN",
"middle_name": "MARION",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-04-23",
"last_updated": "2009-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": "IN",
"license": "01027170",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.