Active NPI
Athina Simotas, DO
- Ophthalmology Physician
- Chicago, IL
National Provider Identifier
1043074602
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 125.083710
- Practice address
- 1950 W Polk St
Chicago, IL 60612-3723 - Phone
- (312) 864-6000
- NPI assigned
- Feb 13, 2024
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 125.083710 | IL | Primary |
Addresses
Primary practice location
1950 W Polk St
Chicago, IL 60612-3723
Mailing address
4630 N Kelso Ave
Chicago, IL 60630-4325
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240829002141 | IL | Order and Referring Only - Ophthalmology | 8426597824 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125.083710 | IL | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1707782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721347200000",
"number": "1043074602",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4630 N KELSO AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606304325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1950 W POLK ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606123723",
"telephone_number": "312-864-6000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMOTAS",
"first_name": "ATHINA",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-02-13",
"last_updated": "2024-07-19",
"certification_date": "2024-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "IL",
"license": "125.083710",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2024; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.