Timothy Robert Simic, NURSE PRACTITIONER

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

3015217 Issued in KY

Practice address

1357 Bardstown Rd
Louisville, KY 40204-1353

Phone

(502) 897-6443

NPI assigned

Feb 12, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2004

Medicare assignment

May accept Medicare assignment

Group practices

Cleanslate Medical Group of Kentucky PLLCGroup PAC ID 4486909769, 18 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Cleanslate Medical Group of Kentucky PLLC

  • Addiction Medicine (Internal Medicine) Physician
  • Louisville, KY
  • NPI 1538600630
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1613088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647475200000",
    "number": "1053904896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 ORMOND RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402071903",
            "telephone_number": "502-558-9325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1357 BARDSTOWN RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402041353",
            "telephone_number": "502-897-6443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMIC",
        "first_name": "TIMOTHY",
        "middle_name": "ROBERT",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-02-12",
        "last_updated": "2022-03-17",
        "certification_date": "2022-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "KY",
            "license": "1102450",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3015217",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100571750",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicholas Silvestros, OD
• Debra Jean Simcoe, LMT
• Simetria
• Simetria Fall Prevention Center, LLC
• Simetria Fall Prevention Centers LLC
• Heather Simindinger, PTA
• Maryjane Simione
• Samuel McDonald Simkoff, APRN
• Juli Stover Simler, RPH
• Rebecca Marie Simmel, APRN

• Family Nurse Practitioner in Louisville, KY
• Providers in Louisville, KY by specialty
• Family Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.