Mary K. Simonson, MD PLLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

MARY K. SIMONSON, MD PLLC

Practice address

4041 Ruston Way Ste 202
Tacoma, WA 98402-5300

Phone

(253) 759-0288

Fax

(253) 761-3288

NPI assigned

Oct 19, 2020

Organization subpart

No

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

Authorized official

Name

Mary K Simonson, MDNPI 1316948359

Title

Owner

Phone

(253) 759-0288

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mary K. Simonson, MD Former legal business name

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mary Kristine Simonson, M.D.

  • Psychiatry Physician
  • Tacoma, WA
  • NPI 1316948359
  Medicare reassignment NPD Authorized official
• Rie Marie Adriana Sharky, M.D.

  • Psychiatry Physician
  • Tacoma, WA
  • NPI 1730576778
  NPD
• Audrey A. Glenn, PH.D.

  • Psychologist
  • Tacoma, WA
  • NPI 1184610735
  NPD (past)
• Mary Kathryn Hamilton, PH. D.

  • Psychologist
  • Tacoma, WA
  • NPI 1902871320
  NPD (past)
• Kirstin B Kirschner, MD

  • Psychiatry Physician
  • Tacoma, WA
  • NPI 1649221490
  NPD (past)
• Gregory Scott Sidell, M.D.

  • Psychiatry Physician
  • Tacoma, WA
  • NPI 1780603530
  NPD (past)

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

{
    "created_epoch": "1603065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603065600000",
    "number": "1295334555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4041 RUSTON WAY STE 202",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984025300",
            "telephone_number": "253-759-0288",
            "fax_number": "253-761-3288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4041 RUSTON WAY STE 202",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984025300",
            "telephone_number": "253-759-0288",
            "fax_number": "253-761-3288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY K. SIMONSON, MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-19",
        "last_updated": "2020-10-19",
        "certification_date": "2020-10-19",
        "status": "A",
        "authorized_official_last_name": "SIMONSON",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-759-0288",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON STATE DEPARTMENT OF HEALTH MEDICAL LICENSE",
            "identifier": "MD0021289",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mary K. Simonson, MD",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Erik Marubayashi
• Dennis Marubi
• Marvin M. Brooke MD
• Mary Bridge Children's Hospital
• Mary Bridge Childrens Health Alliance
• Mary's Tender Care Adult Family Home LLC
• Marys Access Clinic PLLC (M.A.C Health care, M.A.C Aesthetics)
• Rose Elizabeth Marzano, PEER COUNSELOR
• Lynn Catherine Marzoni, LICSW
• William G Marzullo, M.D.

• Medical Specialty Clinic/Center in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Medical Specialty Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.