Individual provider Active NPI

Beverly Elander Simon, LCSW

  • Clinical Social Worker
  • Vacaville, CA
National Provider Identifier
1275291775
Registry record updated Mar 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
28583 Issued in CA
Practice address
607 Elmira Rd # 166
Vacaville, CA 95687-4655
Phone
(707) 365-7436
NPI assigned
Dec 1, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 28583 CA Primary

Addresses

Primary practice location

607 Elmira Rd # 166
Vacaville, CA 95687-4655

Mailing address

607 Elmira Rd # 166
Vacaville, CA 95687-4655
Phone (707) 365-7436

Other practice location 1

101 Bodin Cir
Travis AFB, CA 94535-1809
Phone (707) 365-7436

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20240515000691 CA Practitioner - Clinical Social Worker 7618318171 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Talkspace Provider Network Ca PCGroup PAC ID 7719339548, 29 clinicians

Practice addresses (Care Compare)

74876 Serrano Dr
Twentynine Palms, CA 92277-3740
Phone (212) 284-7206

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
28583CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Talkspace Provider Network Ca PC CurrentSince Apr 1, 2024 Accepting new patients

Locations

2578 Broadway
#607
New York, NY 10025
Phone (516) 847-5432

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": "1638316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742169600000",
    "number": "1275291775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "607 ELMIRA RD # 166",
            "city": "VACAVILLE",
            "state": "CA",
            "postal_code": "956874655",
            "telephone_number": "707-365-7436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 ELMIRA RD # 166",
            "city": "VACAVILLE",
            "state": "CA",
            "postal_code": "956874655",
            "telephone_number": "707-365-7436"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 Bodin Cir",
            "address_purpose": "LOCATION",
            "city": "Travis AFB",
            "state": "CA",
            "postal_code": "945351809",
            "country_code": "US",
            "telephone_number": "707-365-7436",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIMON",
        "first_name": "BEVERLY",
        "middle_name": "ELANDER",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-01",
        "last_updated": "2025-03-17",
        "certification_date": "2025-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "28583",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vacaville, CA

Sources for this page

Verify at the official NPI Registry.