Active NPI
Peter John Simon, M.D.
- Pediatrics Physician
- San Rafael, CA
National Provider Identifier
1114244175
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A120382
- Practice address
- 3110 Kerner Blvd
San Rafael, CA 94901-5411 - Phone
- (415) 448-1500
- NPI assigned
- Apr 29, 2010
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A120382 | CA | Primary |
Addresses
Primary practice location
3110 Kerner Blvd
San Rafael, CA 94901-5411
Mailing address
3110 Kerner Blvd
San Rafael, CA 94901-5411
Phone (415) 448-1500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- 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 |
|---|---|---|---|---|
| I20151210001525 | CA | Order and Referring Only - Pediatric Medicine | 5890096119 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 120382 | CA | MD | Marriage & Family Therapist |
| A120382 | CA | MD | Pediatrics Physician |
Interoperability endpoints
- psimon585294@direct.ochin.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1272499200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1776816000000",
"number": "1114244175",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3110 KERNER BLVD",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949015411",
"telephone_number": "415-448-1500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3110 KERNER BLVD",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949015411",
"telephone_number": "415-448-1500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMON",
"first_name": "PETER",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-04-29",
"last_updated": "2026-04-22",
"certification_date": "2026-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Pediatrics",
"state": "CA",
"license": "A120382",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2026; 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.