Individual provider Active NPI

Mary L Simmons, APN

  • Adult Health Nurse Practitioner
  • Ridgewood, NJ
National Provider Identifier
1386040905
Registry record updated Nov 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
26NJ00515500 Issued in NJ
Practice address
29 Richmond Ave
Ridgewood, NJ 07450-4224
Phone
(201) 251-9242
NPI assigned
Nov 10, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 10, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 26NJ00515500 NJ Primary

Addresses

Primary practice location

29 Richmond Ave
Ridgewood, NJ 07450-4224

Mailing address

29 Richmond Ave
Ridgewood, NJ 07450-4224
Phone (201) 251-9242

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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

Enrollment IDStateProvider typePAC IDDetails
I20150330000370 NJ Practitioner - Nurse Practitioner 0547587693 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Geriatrics and Longevity Treatment Specialist, PCGroup PAC ID 3072787308, 9 clinicians

Practice addresses (Care Compare)

164 Winthrop PL
Englewood, NJ 07631-3054

810 Main St
Hackensack, NJ 07601-4847
Phone (201) 633-7375

Hospital & facility affiliations

  • Valley Hospital Hospital, Paramus, NJ, CCN 310012

Merit-based Incentive Payment System (MIPS)

Final score
94.94 of 100Reported as group
Quality
100
Improvement activities
40
Cost
56.48

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
26NJ00515500NJMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Geriatrics and Longevity Treatment Specialist, PC CurrentSince Feb 1, 2015 Accepting new patients

Locations

810 Main St
Hackensack, NJ 07601
Phone (201) 488-6728

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.

Hospital & facility affiliations 1

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": "1415577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415577600000",
    "number": "1386040905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 RICHMOND AVE",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074504224",
            "telephone_number": "201-251-9242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 RICHMOND AVE",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074504224",
            "telephone_number": "201-251-9242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMMONS",
        "first_name": "MARY",
        "middle_name": "L",
        "credential": "APN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-11-10",
        "last_updated": "2014-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NJ",
            "license": "26NJ00515500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgewood, NJ

Sources for this page

Verify at the official NPI Registry.