Thomas Bullock Simon, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

12286299-0501 Issued in UT

Practice address

6405 S 3000 E Ste 300
Holladay, UT 84121-6977

Phone

(801) 266-3113

Fax

(801) 931-2166

NPI assigned

May 25, 2018

Last updated

Feb 5, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

Kent State University College of Podiatric Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Taylor G Wright PCGroup PAC ID 8426362450, 28 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: thomas@twd-ut.direct.office.nextgen.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Innovation Medical Group PC

  dba Innovation Medical Group

  • Podiatrist
  • Salt Lake City, UT
  • NPI 1235526682
  Medicare reassignment Care Compare group NPD
• Taylor G Wright PC

  dba Innovation Medical Group

  • Podiatrist
  • Layton, UT
  • NPI 1528765575
  NPD

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

{
    "created_epoch": "1527206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707091200000",
    "number": "1356832398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6405 S 3000 E STE 300",
            "city": "HOLLADAY",
            "state": "UT",
            "postal_code": "841216977",
            "telephone_number": "801-266-3113",
            "fax_number": "801-931-2166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6405 S 3000 E STE 300",
            "city": "HOLLADAY",
            "state": "UT",
            "postal_code": "841216977",
            "telephone_number": "801-266-3113",
            "fax_number": "801-931-2166"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12121 Richmond Ave Ste 417",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770822439",
            "country_code": "US",
            "telephone_number": "281-597-1630",
            "fax_number": "281-531-9600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6405 S 3000 E Ste 201",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841216990",
            "country_code": "US",
            "telephone_number": "801-266-3113",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "836 S Angel St Ste 102",
            "address_purpose": "LOCATION",
            "city": "Layton",
            "state": "UT",
            "postal_code": "840413687",
            "country_code": "US",
            "telephone_number": "801-544-6400",
            "fax_number": "801-823-6595",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIMON",
        "first_name": "THOMAS",
        "middle_name": "BULLOCK",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-25",
        "last_updated": "2024-02-05",
        "certification_date": "2024-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "TX",
            "license": "T17-2018",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "UT",
            "license": "12286299-0501",
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "UT",
            "license": "12286299-0501",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4071953",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Seth Knight MD LLC
• Sheetal Shah, MD
• Olesya Shcheglovitova, RPH
• Signature Utah Dental Partners PC (Bingham Dental)
• James Silvestri, MSW, CSW
• Nancy Montgomery Simson, CCP
• Skezics Corporation (Right Direction Crisis Intervention)
• J. Richard Smart, D.D.S.
• Douglas Roland Smith, M.D.
• James Kimball Smith, LCSW

• Podiatrist in Holladay, UT
• Providers in Holladay, UT by specialty
• Podiatrist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.