Individual provider Active NPI

Simone J Simone, PHD

  • Clinical Psychologist
  • Gulfport, MS
National Provider Identifier
1508873928
Registry record updated Feb 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
35-591 Issued in MS
Practice address
10585 Three Rivers Rd Ste C
Gulfport, MS 39503-3572
Phone
(228) 604-0099
Fax
(228) 604-2001
NPI assigned
Aug 1, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 8, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 35-591 MS Primary

Addresses

Primary practice location

10585 Three Rivers Rd Ste C
Gulfport, MS 39503-3572

Mailing address

10585 Three Rivers Rd
Ste C
Gulfport, MS 39503-3572
Phone (228) 604-0099

Other identifiers 1

IdentifierTypeStateIssuer
00118696MedicaidMS

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20111122000173 MS Practitioner - Clinical Psychologist 9032383450 Practice locations: Gulfport, MS

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

10585 Three Rivers Rd
Suite C
Gulfport, MS 39503-3572
Phone (228) 604-0099

10585 Three Rivers Rd C
Gulfport, MS 39503-3572

National Provider Directory

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

Interoperability endpoints

  • Direct secure messaging: ssimone@direct.mhg.com

NPI Registry JSON

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486512000000",
    "number": "1508873928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10585 THREE RIVERS RD",
            "address_2": "STE C",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395033572",
            "telephone_number": "228-604-0099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10585 THREE RIVERS RD STE C",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395033572",
            "telephone_number": "228-604-0099",
            "fax_number": "228-604-2001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMONE",
        "first_name": "SIMONE",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-01",
        "last_updated": "2017-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MS",
            "license": "35-591",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00118696",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

Verify at the official NPI Registry.