Active NPI
Jennifer B Simoni, PA
- Physician Assistant
- Fayetteville, NC
National Provider Identifier
1366486920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0010-00332
- Practice address
- 1540 Purdue Dr Ste 200
Fayetteville, NC 28303-5510 - Phone
- (910) 630-1112
- Fax
- (910) 425-1110
- NPI assigned
- Jun 15, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0010-00332 | NC | Primary |
Addresses
Primary practice location
1540 Purdue Dr Ste 200
Fayetteville, NC 28303-5510
Mailing address
PO Box 64575
Fayetteville, NC 28306-0575
Phone (910) 630-1112
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2625033 | Other | NC | UHC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 007412 | NY | MD | Pediatric Occupational Therapist |
Interoperability endpoints
- jennifer.simoni.p1@direct.carolinarehab.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632355200000",
"number": "1366486920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 64575",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283060575",
"telephone_number": "910-630-1112",
"fax_number": "910-425-1110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1540 PURDUE DR STE 200",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283035510",
"telephone_number": "910-630-1112",
"fax_number": "910-425-1110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMONI",
"first_name": "JENNIFER",
"middle_name": "B",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-15",
"last_updated": "2021-09-23",
"certification_date": "2021-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "0010-00332",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UHC",
"identifier": "2625033",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.