DR. CHARLI WALTER LEROY JR. SMITH (M.D.) – Family Medicine Physician, NPI 1649611252
Family Medicine Physician
Main info
Doctor Profile
Contacts
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for DR. CHARLI WALTER LEROY JR. SMITH (M.D.)
405 Rushing Dr
Herrin, IL 629483730
Phone: (618) 993-3300
Fax: (618) 993-0262
Type: Location
2 S Hospital Dr
Murphysboro, IL 629663333
Phone: (618) 684-1035
Fax: (618) 684-1036
Type: Location
315 S 13th St Ste 3
Herrin, IL 629483666
Phone: (618) 988-6157
Fax: (618) 942-2210
Type: Location
1239 E MAIN ST
PO BOX 3988
CARBONDALE, IL 629013175
Phone: (618) 457-5200
Fax: (618) 351-4820
Type: Mailing
405 RUSHING DR
HERRIN, IL 629483730
Phone: (618) 993-3300
Fax: (618) 993-0262
Type: Location
7209 MOAKE SCHOOL RD
MARION, IL 629597782
Phone: (262) 488-2395
Type: Mailing
608 ROLLIE MOORE DR
HARRISBURG, IL 629462351
Phone: (618) 252-6150
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
Loading prescription activity...
Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2016-06-28
PECOS data refreshed: 2026-06-15
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20160628000691 | I | Family Practice | IL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 62948)
Loading plans...
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | IL | |
| Emergency Medicine | IL | |
| Nurse Practitioner | IL | |
| Emergency Medicine | IL | |
| - | IL | |
| N E U R O L O G Y | IL | |
| U R O L O G Y | IL | |
| D E R M A T O L O G Y | MO | |
| General Surgery | IL | |
| - | IL |
Reviews
All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.
No reviews yet. Be the first to share your experience — your opinion helps families compare providers.