Carolyn Elizabeth Simmons, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD170122 Issued in OR

Practice address

480 Wartahoo LN
Canyonville, OR 97417-9683

Phone

(541) 839-1345

Fax

(855) 670-1791

NPI assigned

Jan 21, 2006

Last updated

Apr 1, 2019By the provider in NPPES

Sex

Female

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 5

Other names 1

• Carolyn Simmons-Rancour Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Cow Creek Band of Umpqua Tribe of Indians

  dba Cow Creek Health & Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Canyonville, OR
  • NPI 1134567993
  NPD

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

{
    "created_epoch": "1137801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554076800000",
    "number": "1417937673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2371 NE STEPHENS ST STE 200",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974701399",
            "telephone_number": "541-672-8533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 WARTAHOO LN",
            "city": "CANYONVILLE",
            "state": "OR",
            "postal_code": "974179683",
            "telephone_number": "541-839-1345",
            "fax_number": "855-670-1791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMMONS",
        "first_name": "CAROLYN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-21",
        "last_updated": "2019-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60385919",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "9151",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD170122",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20-16738",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON STATE DEPARTMENT OF HEALTH",
            "identifier": "MD60385919",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NV BOARD OF PHARMACY",
            "identifier": "CS09655",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON MEDICAL BOARD",
            "identifier": "MD170122",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEVADA STATE BOARD OF MED",
            "identifier": "9151",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAROLYN",
            "last_name": "SIMMONS-RANCOUR",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Reanna Marie Meisner
• Michelle Lynn Reisig, PT
• Valerie Lee Reneau, LMT
• Tari Ellen Shapiro, RPH
• James Brian Siegel, DC
• David Allen Stevens, R.PH.
• Shannon Briana Suhr, FNP
• Shelly Rea Sullens, DMD
• Sarah L Swanson
• Nicole C Taber, LMT

• Family Medicine Physician in Canyonville, OR
• Providers in Canyonville, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.