Wayne Vern Simmons, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

63010002494 Issued in MI

Practice address

2226 S Airport Rd W
Ste. a
Traverse City, MI 49684-4706

Phone

(231) 947-2442

Fax

(231) 947-2446

NPI assigned

Jan 15, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477604601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14300 SEVEN HILLS RD",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496868706",
            "telephone_number": "231-223-4527",
            "fax_number": "231-223-4527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2226 S AIRPORT RD W",
            "address_2": "STE. A",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496844706",
            "telephone_number": "231-947-2442",
            "fax_number": "231-947-2446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMMONS",
        "first_name": "WAYNE",
        "middle_name": "VERN",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "63010002494",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristine A Siemer, OTR/L, CHT
• Robert F Sigworth, M.D.
• Breanne Sika
• Calvin George Sikarskie, MS, LMSW
• Adriano Oliveira Silva
• James Joseph Simons, MD
• Jason Simpkins, LMSW
• Simply Speaking Speech Pathology, PLLC
• Tiffany Simpson, LLPC
• Allison Simsa, PHARM D

• Clinical Psychologist in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.