Individual provider Active NPI

Jonathan T Simon, M.D.

  • Internal Medicine Physician
  • Ansonia, CT
National Provider Identifier
1073565511
Registry record updated Sep 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
46849 Issued in CT
Practice address
22 Westfield Ave
Ansonia, CT 06401
Phone
(203) 736-9919
Fax
(203) 735-2055
NPI assigned
May 16, 2006
Last updated
Sep 26, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2018

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 234884 NY
Internal Medicine Physician 207R00000X 46849 CT Primary
Gastroenterology Physician 207RG0100X 234884 NY
Gastroenterology Physician 207RG0100X 46849 CT

Addresses

Primary practice location

22 Westfield Ave
Ansonia, CT 06401

Mailing address

67 Maple Ave FL 2
Derby, CT 06418-1328
Phone (203) 732-1330

Other identifiers 1

IdentifierTypeStateIssuer
008002867MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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

Enrollment IDStateProvider typePAC IDDetails
I20090210000634 CT Practitioner - Gastroenterology 4385634583 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
State University of New York Downstate Medical Center, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Griffin Faculty Physicians IncGroup PAC ID 7618871997, 125 clinicians

Practice addresses (Care Compare)

130 Division St
Derby, CT 06418-1326
Phone (203) 732-1352

144 Oxford Rd
Suite 1a
Oxford, CT 06478-1982
Phone (203) 888-5527

22 Westfield Ave
Ansonia, CT 06401-1158

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as group
Quality
0
Promoting interoperability
0
Improvement activities
0
Cost
0

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy31
Upper gastrointestinal (GI) endoscopy for acid reflux47

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
46849CTMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Griffin Faculty Physicians, Inc. Internal Medicine CurrentSince Oct 1, 2013 Accepting new patients
Jordan Physician Associates, Inc. Past Accepting new patients
Jordan Physician Associates, Inc. Internal Medicine Past Accepting new patients

Locations

130 Division St
Derby, CT 06418
Phone (203) 732-1330

67 Maple Ave
Derby, CT 06418
Phone (203) 732-0699

67 Maple Ave
Fl 2
Derby, CT 06418
Phone (203) 732-1330

Interoperability endpoints

  • Direct secure messaging: jonathan.simon.1@1323.direct.athenahealth.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537920000000",
    "number": "1073565511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 MAPLE AVE FL 2",
            "city": "DERBY",
            "state": "CT",
            "postal_code": "064181328",
            "telephone_number": "203-732-1330",
            "fax_number": "203-732-1332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 WESTFIELD AVE",
            "city": "ANSONIA",
            "state": "CT",
            "postal_code": "06401",
            "telephone_number": "203-736-9919",
            "fax_number": "203-735-2055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMON",
        "first_name": "JONATHAN",
        "middle_name": "T",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2018-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "234884",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "46849",
            "primary": true
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": "234884",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CT",
            "license": "46849",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008002867",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ansonia, CT

Sources for this page

Verify at the official NPI Registry.