Brent Simon, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601006442 Issued in MI

Practice address

204 W 3Rd St
Pinconning, MI 48650-9622

Phone

(989) 879-3771

Fax

(989) 879-3788

NPI assigned

Aug 29, 2012

Sex

Male

Sole proprietor

No

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.

• Wellness Family Practice P.C.

  • Family Medicine Physician
  • Bay City, MI
  • NPI 1457596223
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 12, 2013.

{
    "created_epoch": "1346198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360627200000",
    "number": "1326397993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 WOODSIDE AVE",
            "city": "ESSEXVILLE",
            "state": "MI",
            "postal_code": "487321234",
            "telephone_number": "989-892-7722",
            "fax_number": "989-892-7455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 W 3RD ST",
            "city": "PINCONNING",
            "state": "MI",
            "postal_code": "486509622",
            "telephone_number": "989-879-3771",
            "fax_number": "989-879-3788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMON",
        "first_name": "BRENT",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-29",
        "last_updated": "2013-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601006442",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN GROUP",
            "identifier": "MI1566",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1326397993",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pinconning Medical Center P.C.
• Pinny Pharmacy Inc
• Brent J Raap, DO
• Randy J O Laughlin DDS PC
• Jenette M Roth
• Sterling Area Health Center
• Thomas Joseph Trombley, DC
• Dana Trudell
• Visiting Nurse Services of Michigan
• Victoria Lauren Wise

• All providers in Pinconning, MI
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.