Sam Simon, CRNP

Primary specialty

Adult Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0809X

License

RN675125 Issued in PA

Practice address

4200 Monument Road
Outpatient Building
Philadelphia, PA 19131-1689

Phone

(215) 877-2000

NPI assigned

Sep 8, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Belmont Behavioral Hospital, LLC

  • Psychiatric Hospital
  • Philadelphia, PA
  • NPI 1629468137
  Medicare reassignment NPD
• Belmont Behavioral Hospital, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Philadelphia, PA
  • NPI 1346621448
  NPD

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

{
    "created_epoch": "1662595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662595200000",
    "number": "1326769399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 MONUMENT ROAD",
            "address_2": "OUTPATIENT BUILDING",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191311689",
            "telephone_number": "215-877-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 MONUMENT ROAD",
            "address_2": "OUTPATIENT BUILDING",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191311689",
            "telephone_number": "215-877-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMON",
        "first_name": "SAM",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-09-08",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "PA",
            "license": "RN675125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Simon, M.D.
• Rachel C Simon
• Rachel E Simon, MSW, LCSW, MED
• Rebecca E Simon, MD
• Robert W Simon, CRNA
• Tonae Simon, BSN, RN, IBCLC
• Gina M Simoncini, MD
• William Robert Simonds, DO
• Mark J Simone-Skidmore, M.D.
• Andrea Marie Simone

• Adult Psychiatric/Mental Health Registered Nurse in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Adult Psychiatric/Mental Health Registered Nurse in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.