Active NPI
Brady Simpkins, PA-C
- Physician Assistant
- Fort Drum, NY
National Provider Identifier
1023305729
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 11050 Mount Belvedere Blvd
Fort Drum, NY 13602-5438 - Phone
- (802) 258-0301
- NPI assigned
- Jun 30, 2011
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
11050 Mount Belvedere Blvd
Fort Drum, NY 13602-5438
Mailing address
11050 Mount Belvedere Blvd
Fort Drum, NY 13602-5438
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 016765 | NY | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309392000000",
"number": "1023305729",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11050 MOUNT BELVEDERE BLVD",
"city": "FORT DRUM",
"state": "NY",
"postal_code": "136025438"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11050 MOUNT BELVEDERE BLVD",
"city": "FORT DRUM",
"state": "NY",
"postal_code": "136025438",
"telephone_number": "802-258-0301"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMPKINS",
"first_name": "BRADY",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-30",
"last_updated": "2011-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Drum, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.