Simon St. John Prendiville, MD

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

200300278 Issued in NC

Practice address

2015 Randolph Road
Suite 208
Charlotte, NC 28207-1200

Phone

(704) 377-4009

NPI assigned

May 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Charlotte Gastroenterology & Hepatology, PLLC

  • Gastroenterology Physician
  • Huntersville, NC
  • NPI 1730100801

  Gastroenterology, NC

  Medicare reassignment Care Compare group NPD
• Charlotte Gastroenterology & Hepatology, PLLC

  • Ambulatory Surgical Clinic/Center
  • Charlotte, NC
  • NPI 1851548655

  NC

  Medicare reassignment Care Compare group NPD
• Charlotte Gastroenterology & Hepatology, PLLC

  • Ambulatory Surgical Clinic/Center
  • Charlotte, NC
  • NPI 1619124401
  Care Compare group NPD (past)

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

• Novant Health Matthews Medical Center LLC

  • General Acute Care Hospital
  • Matthews, NC
  • NPI 1063463156

  Hospital

  Care Compare affiliation
• Novant Health Mint Hill Medical Center, LLC

  • General Acute Care Hospital
  • Charlotte, NC
  • NPI 1972001469

  Hospital

  Care Compare affiliation
• The Presbyterian Hospital

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Charlotte, NC
  • NPI 1396798591

  Hospital

  Care Compare affiliation
• The Presbyterian Hospital

  • Psychiatric Hospital Unit
  • Charlotte, NC
  • NPI 1497708838

  Hospital

  Care Compare affiliation
• The Presbyterian Hospital

  • General Acute Care Hospital
  • Charlotte, NC
  • NPI 1881647204

  Hospital

  Care Compare affiliation
• The Presbyterian Hospital

  • Skilled Nursing Facility
  • Charlotte, NC
  • NPI 1891871901

  Hospital

  Care Compare affiliation

Specialty

Gastroenterology

Education

Georgetown University School of Medicine, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Charlotte Gastroenterology and Hepatology PLLC 76 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Novant Health Presbyterian Medical Center Hospital, Charlotte, NC, CCN 340053
• Novant Health Matthews Medical Center Hospital, Matthews, NC, CCN 340171
• Novant Health Mint Hill Medical Center Hospital, Charlotte, NC, CCN 340190

Merit-based Incentive Payment System (MIPS)

Final score

95.22 of 100Reported as group

Quality

100

Promoting interoperability

100

Improvement activities

40

Cost

84.08

Procedures performed for Medicare patients

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649116800000",
    "number": "1023076353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13808 PROFESSIONAL CENTER DR",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280787948",
            "telephone_number": "704-377-4009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 RANDOLPH ROAD",
            "address_2": "SUITE 208",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071200",
            "telephone_number": "704-377-4009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRENDIVILLE",
        "first_name": "SIMON",
        "middle_name": "ST. JOHN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NC",
            "license": "200300278",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Premise Health of North Carolina Medical PC
• Premise Health of North Carolina Medical, P.C
• Premise Health of North Carolina Medical, P.C
• Premium Home Care Services LLC
• Makaela Premont, PHARMD, RPH
• Kirsten L. Presby, NP
• Presbyterian Breast Center LLC
• Presbyterian Breast Center LLC
• Presbyterian Breast Center LLC
• Presbyterian Breast Center, LLC

• All providers in Charlotte, NC
• Gastroenterology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; 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.