Segun V Simon, MD

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

25MA08683000 Issued in NJ

Practice address

2130 Millburn Ave
Suite C-3
Maplewood, NJ 07040-3725

Phone

(973) 996-2727

Fax

(973) 763-2558

NPI assigned

Aug 4, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

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

Specialty

Internal MedicineAlso: Nephrology

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• DaVita Irvington Dialysis Dialysis facility, Irvington, NJ, CCN 312683
• DaVita East Orange Dialysis Dialysis facility, East Orange, NJ, CCN 312522
• Newark Beth Israel Medical Center Hospital, Newark, NJ, CCN 310002
• Cooperman Barnabas Medical Center Hospital, Livingston, NJ, CCN 310076
• Clara Maass Medical Center Hospital, Belleville, NJ, CCN 310009

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Kidney Care PA

  • Nephrology Physician
  • Maplewood, NJ
  • NPI 1871918615
  Medicare reassignment NPD
• Guy a. Francis, MD,L.L.C.

  • Family Medicine Physician
  • Maplewood, NJ
  • NPI 1316051014
  NPD (past)
• Newark Beth Israel Medical Center Inc

  • General Acute Care Hospital
  • Newark, NJ
  • NPI 1215027966
  NPD (past)
• Total Support Medical Group Inc.

  • Internal Medicine Physician
  • Irvington, NJ
  • NPI 1467510776
  NPD (past)

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

• Buckhorn Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Irvington, NJ
  • NPI 1689176141

  Dialysis facility

  Care Compare affiliation Name & address match
• Kidney Life, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • East Orange, NJ
  • NPI 1548299373

  Dialysis facility

  Care Compare affiliation Name & address match
• Clara Maass Medical Center

  • General Acute Care Hospital
  • Belleville, NJ
  • NPI 1902901333
  Care Compare affiliation
• Cooperman Barnabas Medical Center Inc

  • General Acute Care Hospital
  • Livingston, NJ
  • NPI 1396857488
  Care Compare affiliation
• Newark Beth Israel Medical Center Inc

  • General Acute Care Hospital
  • Newark, NJ
  • NPI 1215027966
  Care Compare affiliation

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

{
    "created_epoch": "1249344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416614400000",
    "number": "1194956490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 373",
            "city": "SHORT HILLS",
            "state": "NJ",
            "postal_code": "070780373",
            "telephone_number": "973-996-2727",
            "fax_number": "973-763-2558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2130 MILLBURN AVE",
            "address_2": "SUITE C-3",
            "city": "MAPLEWOOD",
            "state": "NJ",
            "postal_code": "070403725",
            "telephone_number": "973-996-2727",
            "fax_number": "973-763-2558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMON",
        "first_name": "SEGUN",
        "middle_name": "V",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-04",
        "last_updated": "2014-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NJ",
            "license": "25MA08683000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0371254",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shantise Michelle LLC
• Robert Shekitka, DMD
• Lancy Siby
• Susan D Siegeltuch, LCSW
• Rejane Signor, NP
• Chenelle Sinclair
• Shawn L Sklar-Reitman, CNM
• Skyview Health Services LLC
• Shakira Latasha Slater, M.D.
• Malaika A Small, LCSW

• Nephrology Physician in Maplewood, NJ
• Providers in Maplewood, NJ by specialty
• Nephrology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2014; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.