Individual provider Active NPI

Rutanya Simon

  • Clinical Social Worker
  • Tulsa, OK
National Provider Identifier
1215367651
Registry record updated Jul 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
110220 Issued in TX
Practice address
3604 N Martin Luther King Jr Blvd
Tulsa, OK 74106-6447
Phone
(918) 425-4200
Fax
(918) 425-4202
NPI assigned
Nov 21, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X
Clinical Social Worker 1041C0700X ISW04100 RI
Clinical Social Worker 1041C0700X 110220 TX Primary

Addresses

Primary practice location

3604 N Martin Luther King Jr Blvd
Tulsa, OK 74106-6447

Mailing address

650 S Peoria Ave
Tulsa, OK 74120-4429
Phone (918) 587-9471

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240314003553 TX Practitioner - Clinical Social Worker 0042656803 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MCCD FL Psychiatry Services PAGroup PAC ID 4880064070, 751 clinicians

Practice addresses (Care Compare)

3223 S Loop
289 Suite 600
Lubbock, TX 79423-1372
Phone (833) 351-8255

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ISW04100RIMDClinical Social Worker
110220TXMDClinical Social Worker
5848OKMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
MCCD FL Psychiatry Services PA CurrentSince Feb 10, 2026 Accepting new patients
Vcounselors PLLC CurrentSince Feb 3, 2024 Accepting new patients

Locations

3223 S Loop 289
Ste 600
Lubbock, TX 79423
Phone (405) 314-0960

5522 Lone Star Pkwy
Ste 303
San Antonio, TX 78253
Phone (210) 614-4990

Organizations & group practices 2

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": "1384992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753228800000",
    "number": "1215367651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 S PEORIA AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741204429",
            "telephone_number": "918-587-9471",
            "fax_number": "918-560-1399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3604 N MARTIN LUTHER KING JR BLVD",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741066447",
            "telephone_number": "918-425-4200",
            "fax_number": "918-425-4202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMON",
        "first_name": "RUTANYA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-21",
        "last_updated": "2025-07-23",
        "certification_date": "2025-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": "ISW04100",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "110220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.