NPIMap

Individual provider Active NPI

John K Simonson, MD

  • Family Medicine Physician
  • Blair, NE
National Provider Identifier
1124091921
Registry record updated Oct 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
19620 Issued in NE
Practice address
812 N 22ND St
Blair, NE 68008
Phone
(402) 426-4611
Fax
(402) 426-4642
NPI assigned
Feb 10, 2006
Last updated
Oct 2, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 19620 NE Primary

Addresses

Primary practice location

812 N 22ND St
Blair, NE 68008

Mailing address

812 N 22ND St
Blair, NE 68008-1128
Phone (402) 426-4611

Other identifiers 2

IdentifierTypeStateIssuer
47042628508MedicaidNE
10025024000OtherNEMEDICAID RHC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051214000147 NE Practitioner - Family Practice 5395766620 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Nebraska College of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3519 Hwy 32
Tekamah, NE 68061-5095
Phone (402) 374-1585

810 N 22ND St
Blair, NE 68008-1128
Phone (402) 426-2182

812 N 22ND St
Blair, NE 68008-1128
Phone (402) 426-4611

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
19620NEMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Community Hospital Corporation CurrentSince Sep 1, 1997 Accepting new patients
Memorial Community Hospital Corporation Family Medicine CurrentSince Sep 1, 1997 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Crowell Memorial Home Past Accepting new patients
Blair NF Operations LLC Past Accepting new patients

Locations

810 N 22nd St
Blair, NE 68008
Phone (402) 426-1116

812 N 22nd St
Blair, NE 68008
Phone (402) 426-4611

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Good Shepherd Lutheran HomeBlair, NE, CCN 285148 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jun 29, 2023
Jun 29, 2023

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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 5

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": "1139529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727827200000",
    "number": "1124091921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "812 N 22ND ST",
            "city": "BLAIR",
            "state": "NE",
            "postal_code": "680081128",
            "telephone_number": "402-426-4611",
            "fax_number": "402-426-4642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 N 22ND ST",
            "city": "BLAIR",
            "state": "NE",
            "postal_code": "68008",
            "telephone_number": "402-426-4611",
            "fax_number": "402-426-4642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMONSON",
        "first_name": "JOHN",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-10",
        "last_updated": "2024-10-02",
        "certification_date": "2024-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "19620",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47042628508",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID RHC",
            "identifier": "10025024000",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blair, NE

Sources for this page

Verify at the official NPI Registry.