Active NPI
Mark Martin Simonian, MD
- Pediatrics Physician
- Clovis, CA
National Provider Identifier
1265476493
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A32554
- Practice address
- 681 Medical Center Dr W
106
Clovis, CA 93611-6803 - Phone
- (559) 325-6850
- NPI assigned
- Jun 16, 2006
- Last updated
- Mar 16, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A32554 | CA | Primary |
Addresses
Primary practice location
681 Medical Center Dr W
106
Clovis, CA 93611-6803
Mailing address
681 Medical Center Dr W
106
Clovis, CA 93611-6803
Phone (559) 325-6850
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 26-4031266 | Other | CA | IRS S-CORP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A32554 | CA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1237161600000",
"number": "1265476493",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "681 MEDICAL CENTER DR W",
"address_2": "106",
"city": "CLOVIS",
"state": "CA",
"postal_code": "936116803",
"telephone_number": "559-325-6850"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "681 MEDICAL CENTER DR W",
"address_2": "106",
"city": "CLOVIS",
"state": "CA",
"postal_code": "936116803",
"telephone_number": "559-325-6850"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMONIAN",
"first_name": "MARK",
"middle_name": "MARTIN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-16",
"last_updated": "2009-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A32554",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IRS S-CORP",
"identifier": "26-4031266",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clovis, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.