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Deactivated NPI 1912262148 Deactivated / Inactive NPI Male Practitioner

Stacy Douglas Smith , AT, C

Specialist/Technologist - Athletic Trainer • Newark, NJ

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Stacy Smith has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date July 13, 2012
NPI Deactivation Date August 10, 2012
Total Practice Duration ~1 Years of Practice (2012 – 2012)

Professional Overview & Biography Verified Profile Summary

Stacy Smith, AT, C was a registered Specialist/Technologist - Athletic Trainer practicing in Newark, NJ. Throughout an active medical career spanning 1 years, Stacy Smith provided care at the practice location at 80 JOHNSON AVE until profile deactivation on 2012-08-10.

Practice Location & Contact Primary Location

Practice Address

80 Johnson Ave
Shabazz

Newark, NJ 07108

Telephone 9737444113
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Specialist/Technologist - Athletic Trainer in Newark, NJ

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 2.5 Yrs
Regional Practice Density
21 Specialists

Practicing in Newark, NJ (1155 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Specialist/Technologist - Athletic Trainer Primary Specialty

NUCC Taxonomy Code: 2255A2300X

State License NJ 25MT00037500

Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor's degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees. National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation. Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Reactivated June 14, 2016

Record officially reactivated for active practice on June 14, 2016

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Updated Practice Location June 14, 2016

Registered at 80 JOHNSON AVE, SHABAZZ, NEWARK, NJ 07108 (Tel: 9737444113)

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Updated Business Mailing Address June 14, 2016

Registered at 80 JOHNSON AVE, SHABAZZ, NEWARK, NJ 07108 (Tel: 9737444113)

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Provider Name / Credentials Updated June 14, 2016

Recorded as STACY SMITH, A.T.,C

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Medical Taxonomy / Specialty Registered (Primary Specialty) June 14, 2016

Specialist/Technologist (License #25MT00037500 in NJ)

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NPI Profile Deactivated August 10, 2012

Record deactivated on August 10, 2012

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Initial NPI Registration & Enumeration July 13, 2012

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1912262148
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 13, 2012
Last Update: June 14, 2016
Deactivation Date: August 10, 2012
Sole Proprietor: Yes

Mailing Address

80 Johnson Ave, Shabazz

Newark, NJ 07108

Phone: 9737444113

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.