Individual provider Active NPI

Mark D Simms, MD

  • Pediatric Neurodevelopmental Disabilities Physician
  • Brookfield, WI
National Provider Identifier
1154373918
Registry record updated Oct 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Neurodevelopmental Disabilities PhysicianTaxonomy code 2080P0008X
License
35801 Issued in WI
Practice address
13800 W North Ave
Child Development Center of CHW
Brookfield, WI 53005-4977
Phone
(262) 432-6600
Fax
(262) 432-6604
NPI assigned
May 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Neurodevelopmental Disabilities Physician 2080P0008X 35801 WI Primary

Addresses

Primary practice location

13800 W North Ave
Child Development Center of CHW
Brookfield, WI 53005-4977

Mailing address

13800 W North Ave
Child Development Center of CHW
Brookfield, WI 53005-4977
Phone (262) 432-6600

Other identifiers 2

IdentifierTypeStateIssuer
002000135ZOtherHUMANA
1154373918MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20040126000271 WI Practitioner - Pediatric MedicinePractitioner - Neurology 8426950809 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35801WIMDPediatric Neurodevelopmental Disabilities Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Medical College of Wisconsin, Inc. CurrentSince Mar 18, 2011 Accepting new patients

Locations

10911 N Port Washington Rd
Mequon, WI 53092
Phone (262) 241-2080

Bin 88350
Milwaukee, WI 53288
Phone (414) 805-3122

1601 N Taylor Dr
Sheboygan, WI 53081
Phone (920) 459-4767

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

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": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412899200000",
    "number": "1154373918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13800 W NORTH AVE",
            "address_2": "CHILD DEVELOPMENT CENTER OF CHW",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530054977",
            "telephone_number": "262-432-6600",
            "fax_number": "262-432-6604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13800 W NORTH AVE",
            "address_2": "CHILD DEVELOPMENT CENTER OF CHW",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530054977",
            "telephone_number": "262-432-6600",
            "fax_number": "262-432-6604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMMS",
        "first_name": "MARK",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2014-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0008X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neurodevelopmental Disabilities",
            "state": "WI",
            "license": "35801",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "002000135Z",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1154373918",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookfield, WI

Sources for this page

Verify at the official NPI Registry.