Individual provider Active NPI

Michael Simons, M.D.

  • Cardiovascular Disease Physician
  • New Haven, CT
National Provider Identifier
1063451110
Registry record updated Jan 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
11396 Issued in NH
Practice address
333 Cedar St
New Haven, CT 06510-3206
Phone
(203) 737-4643
NPI assigned
Jun 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 46953 CT
Cardiovascular Disease Physician 207RC0000X 11396 NH Primary

Addresses

Primary practice location

333 Cedar St
New Haven, CT 06510-3206

Mailing address

333 Cedar St
New Haven, CT 06510-3206
Phone (203) 737-4643

Other identifiers 2

IdentifierTypeStateIssuer
ORE6303OtherVTMEDICAID
30201610MedicaidNH

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
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
11396NHMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Great Lakes Orthopaedic Center, P.C. Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578441600000",
    "number": "1063451110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 CEDAR ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065103206",
            "telephone_number": "203-737-4643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 CEDAR ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065103206",
            "telephone_number": "203-737-4643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMONS",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-05",
        "last_updated": "2020-01-08",
        "certification_date": "2020-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CT",
            "license": "46953",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NH",
            "license": "11396",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "ORE6303",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30201610",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.