NPIMap

Individual provider Active NPI

Jon L Simmons, MD

  • Family Medicine Physician
  • Marinette, WI
National Provider Identifier
1336189075
Registry record updated May 31, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
37092 Issued in WI
Practice address
2820 Roosevelt Road
Marinette, WI 54143-3834
Phone
(715) 735-5225
Fax
(715) 735-5388
NPI assigned
Jun 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 37092 WI Primary
Adult Medicine Physician 207QA0505X 4301089159 MI

Addresses

Primary practice location

2820 Roosevelt Road
Marinette, WI 54143-3834

Mailing address

PO Box 1866
Green Bay, WI 54305-1866
Phone (920) 445-7222

Other identifiers 2

IdentifierTypeStateIssuer
32167300MedicaidWI
4957216MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20051011000345 WI Practitioner - Family Practice 2860395779 Reassigns benefits to 1 organization
I20070223000467 MI Practitioner - Family Practice 2860395779 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Wisconsin School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oconto Hospital and Medical Center IncGroup PAC ID 2163461781, shared by 12 NPIs, 217 clinicians

Practice addresses (Care Compare)

2820 Roosevelt Rd
Marinette, WI 54143-3834
Phone (715) 735-5225

820 Arbutus Ave
Oconto, WI 54153-2004
Phone (920) 835-1100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
37092WIMDFamily Medicine Physician
4301089159MIMDAdult Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bellin Memorial Hospital Inc Current Accepting new patients
Bellin Memorial Hospital Inc Family Medicine CurrentSince May 31, 2018 Accepting new patients
Oconto Hospital & Medical Center Inc CurrentSince Nov 1, 2016 Accepting new patients
Oconto Hospital & Medical Center Inc Family Medicine CurrentSince Nov 1, 2016 Accepting new patients
Bellin Memorial Hospital Inc Family Medicine CurrentSince May 31, 2018 Accepting new patients
Northreach Healthcare, LLC Family Medicine Past Accepting new patients

Locations

106 S School Rd
Daggett, MI 49821
Phone (906) 753-2155

440 Woodward Ave
Iron Mountain, MI 49801
Phone (906) 776-9040

2820 Roosevelt Rd
Marinette, WI 54143
Phone (715) 330-6171

820 Arbutus Ave
Oconto, WI 54153
Phone (920) 835-1100

855 S Main St
Oconto Falls, WI 54154
Phone (920) 846-3444

Interoperability endpoints

  • Direct secure messaging: jsimmons33035@direct.thedacare.org
  • Direct secure messaging: jsimmons916505@direct.emplifyhealth.org

Organizations & group practices 6

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.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527724800000",
    "number": "1336189075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1866",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543051866",
            "telephone_number": "920-445-7222",
            "fax_number": "920-445-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2820 ROOSEVELT ROAD",
            "city": "MARINETTE",
            "state": "WI",
            "postal_code": "541433834",
            "telephone_number": "715-735-5225",
            "fax_number": "715-735-5388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMMONS",
        "first_name": "JON",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-08",
        "last_updated": "2018-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "37092",
            "primary": true
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "MI",
            "license": "4301089159",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32167300",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4957216",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marinette, WI

Sources for this page

Verify at the official NPI Registry.