Individual provider Active NPI

Wanda J Simmons Clemmons, MD

  • Adult Medicine Physician
  • Baltimore, MD
National Provider Identifier
1275615775
Registry record updated Jan 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
D0035674 Issued in MD
Practice address
6724 Glenkirk Rd
Baltimore, MD 21239-1410
Phone
(443) 900-3184
Fax
(410) 433-2015
NPI assigned
Oct 20, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 2, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) Physician 207QG0300X D0035674 MD
Adult Medicine Physician 207QA0505X D0035674 MD Primary

Addresses

Primary practice location

6724 Glenkirk Rd
Baltimore, MD 21239-1410

Mailing address

808 Gleneagles CT # 20069
Towson, MD 21286-2205
Phone (443) 900-3184

Other identifiers 2

IdentifierTypeStateIssuer
535071900MedicaidMD
D0035674OtherMDMEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20111118000316 MD Practitioner - Family PracticePractitioner - Geriatric Medicine 3779640420 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Geriatric Medicine
Education
State University of New York Downstate Medical Center, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Medassist NJ IIGroup PAC ID 1557717428, 23 clinicians

Practice addresses (Care Compare)

6724 Glenkirk Rd
Baltimore, MD 21239-1410
Phone (845) 377-6670

Merit-based Incentive Payment System (MIPS)

Final score
19.27 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
64.24

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D0035674MDMDGeriatric Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Signify Health Medical Associates, PLLC CurrentSince Oct 27, 2022 Accepting new patients
Medical Paraclete CurrentSince Nov 21, 2024 Accepting new patients
Medassist NJ II Geriatric Medicine CurrentSince Oct 3, 2023 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

1910 Towne Centre Blvd
Ste 250
Annapolis, MD 21401
Phone (202) 596-8891

2405 York Rd
Ste 201
Timonium, MD 21093
Phone (240) 332-4048

808 Gleneagles Ct
#20069
Towson, MD 21286

747 Chestnut Ridge Rd
Ste 206
Spring Valley, NY 10977
Phone (845) 377-6670

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

Organizations & group practices 4

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": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735776000000",
    "number": "1275615775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 GLENEAGLES CT # 20069",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212862205",
            "telephone_number": "443-900-3184",
            "fax_number": "512-559-7040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6724 GLENKIRK RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212391410",
            "telephone_number": "443-900-3184",
            "fax_number": "410-433-2015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMMONS CLEMMONS",
        "first_name": "WANDA",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-20",
        "last_updated": "2025-01-02",
        "certification_date": "2025-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "MD",
            "license": "D0035674",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "MD",
            "license": "D0035674",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "535071900",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "D0035674",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.