NPIMap

Individual provider Active NPI

Joseph Jordan Simon, D.O.

  • Diagnostic Radiology Physician
  • Charlotte, NC
National Provider Identifier
1407198484
Registry record updated Oct 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
2023-02837 Issued in NC
Practice address
3623 Latrobe Dr Ste 216
Charlotte, NC 28211-2117
Phone
(704) 332-1291
Fax
(704) 926-1832
NPI assigned
Mar 18, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 007692 AZ
Student in an Organized Health Care Education/Training Program 390200000X
Diagnostic Radiology Physician 2085R0202X 2023-02837 NC Primary

Addresses

Primary practice location

3623 Latrobe Dr Ste 216
Charlotte, NC 28211-2117

Mailing address

PO Box 221249
Charlotte, NC 28222-1249
Phone (704) 332-1291

Other practice location 1

3601 W 13 Mile Rd
Royal Oak, MI 48073-6712
Phone (248) 898-6509

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, NC2 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
I20200724001643 MI Practitioner - Diagnostic Radiology 4385945260 Reassigns benefits to 1 organization
I20231023000101 NC Practitioner - Diagnostic Radiology 4385945260 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Michigan Medical School, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mecklenburg Radiology Associates PAGroup PAC ID 6800789587, 95 clinicians

Practice addresses (Care Compare)

3623 Latrobe Dr
Suite 216
Charlotte, NC 28211-2117
Phone (704) 332-1291

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.64 of 100Reported as group
Quality
85.06
Promoting interoperability
100
Improvement activities
40
Cost
77.9

Merit-based Incentive Payment System (MIPS)

Final score
91.03 of 100Reported as group
Quality
98.89
Improvement activities
40
Cost
72.14

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2023-02837NCMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Beaumont Medical Group Hospital -Based Services CurrentSince Jul 31, 2020 Accepting new patients
Mecklenburg Radiology Associates, P.a. Diagnostic Radiology CurrentSince Nov 1, 2023 Accepting new patients
Presbyterian Imaging Centers LLC Diagnostic Radiology CurrentSince Jan 1, 2024 Accepting new patients

Locations

3601 W 13 Mile Rd
Royal Oak, MI 48073

26901 Beaumont Blvd
Ste 3D
Southfield, MI 48033
Phone (947) 522-1860

44201 Dequindre Rd
Troy, MI 48085
Phone (248) 471-8255

3623 Latrobe Dr
Ste 216
Charlotte, NC 28211
Phone (704) 926-1827

Organizations & group practices 3

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 8

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": "1363564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698624000000",
    "number": "1407198484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 221249",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282221249",
            "telephone_number": "704-332-1291",
            "fax_number": "704-926-1832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3623 LATROBE DR STE 216",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282112117",
            "telephone_number": "704-332-1291",
            "fax_number": "704-926-1832"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3601 W 13 Mile Rd",
            "address_purpose": "LOCATION",
            "city": "Royal Oak",
            "state": "MI",
            "postal_code": "480736712",
            "country_code": "US",
            "telephone_number": "248-898-6509",
            "fax_number": "248-898-5490",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIMON",
        "first_name": "JOSEPH",
        "middle_name": "JORDAN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-18",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "AZ",
            "license": "007692",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "2023-02837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.