Individual provider Active NPI

Tamara L Simmerman, MD

  • Pediatrics Physician
  • Spokane Valley, WA
National Provider Identifier
1124187505
Registry record updated Aug 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD38501 Issued in WA
Practice address
1414 N Vercler
Building 1
Spokane Valley, WA 99216-1092
Phone
(509) 928-6383
Fax
(509) 926-9420
NPI assigned
Dec 8, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD38501 WA Primary

Addresses

Primary practice location

1414 N Vercler
Building 1
Spokane Valley, WA 99216-1092

Mailing address

1414 N Vercler Rd
Building 1
Spokane Valley, WA 99216-1092
Phone (509) 928-6383

Other identifiers 1

IdentifierTypeStateIssuer
1003097MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20140127001510 WA Practitioner - Pediatric Medicine 4486883220 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD38501WAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Washington CurrentSince Jan 1, 2014 Accepting new patients
Providence Health & Services - Wa Past Accepting new patients
Providence Health & Services - Washington Past Accepting new patients

Locations

1200 E Columbia Ave
Colville, WA 99114
Phone (509) 684-3701

23813 E Appleway Ave
Liberty Lake, WA 99019
Phone (509) 928-6383

1414 N Vercler Rd
Ste 1
Spokane Valley, WA 99216
Phone (509) 924-4600

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313712000000",
    "number": "1124187505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 N VERCLER RD",
            "address_2": "BUILDING 1",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992161092",
            "telephone_number": "509-928-6383",
            "fax_number": "509-926-9420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 N VERCLER",
            "address_2": "BUILDING 1",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992161092",
            "telephone_number": "509-928-6383",
            "fax_number": "509-926-9420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMMERMAN",
        "first_name": "TAMARA",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-08",
        "last_updated": "2011-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD38501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003097",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane Valley, WA

Sources for this page

Verify at the official NPI Registry.