Individual provider Active NPI

Edwin Simpser, MD

  • Pediatric Gastroenterology Physician
  • Bayside, NY
National Provider Identifier
1376620807
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
162210 Issued in NY
Practice address
2901 216TH St
Bayside, NY 11360-2810
Phone
(718) 281-8778
Fax
(718) 281-8590
NPI assigned
Nov 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Gastroenterology Physician 2080P0206X 162210 NY Primary

Addresses

Primary practice location

2901 216TH St
Bayside, NY 11360-2810

Mailing address

2901 216TH St
Bayside, NY 11360-2810
Phone (718) 281-8778

Other identifiers 1

IdentifierTypeStateIssuer
01125259MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160504000679 NY Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 9032173836

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Olom Home Care, Inc. PastSince Apr 28, 2004 Accepting new patients

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Saint Marys Hospital for Children IncBayside, NY, CCN 335875 Skilled nursing facility Corporate Officer Sep 20, 2013
St. Mary'S Home CareNew Hyde Park, NY, CCN 337438 Home health agency Corporate Officer
Corporate Director
Dec 5, 2010
Dec 5, 2010

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376620807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 216TH ST",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "113602810",
            "telephone_number": "718-281-8778",
            "fax_number": "718-281-8590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 216TH ST",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "113602810",
            "telephone_number": "718-281-8778",
            "fax_number": "718-281-8590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMPSER",
        "first_name": "EDWIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "NY",
            "license": "162210",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01125259",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bayside, NY

Sources for this page

Verify at the official NPI Registry.