Active NPI
Connie D Simmons, M.D.
- Pediatrics Physician
- Maryland Heights, MO
National Provider Identifier
1558468892
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 104168
- Practice address
- 11365 Dorsett Rd.
Maryland Heights, MO 63043 - Phone
- (314) 872-6430
- Fax
- (314) 872-6500
- NPI assigned
- Sep 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 104168 | MO | Primary |
| Pediatric Emergency Medicine (Pediatrics) Physician | 2080P0204X | 104168 | MO |
Addresses
Primary practice location
11365 Dorsett Rd.
Maryland Heights, MO 63043
Mailing address
11365 Dorsett Rd.
Maryland Heights, MO 63043
Phone (314) 872-6430
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 207648007 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 104168 | MO | MD | Pediatric Emergency Medicine (Pediatrics) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ranken-Jordan Home for Convalescent Crippled Children | Past | Accepting new patients | |
| SSM Health Care St. Louis | Pediatrics | Past | Accepting new patients |
| SSM Health Care St. Louis | Pediatrics | Past | Accepting new patients |
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.
-
- General Acute Care Hospital
- Maryland Heights, MO
- NPI 1235117532
-
- Emergency Medical Services (Emergency Medicine) Physician
- Lake St Louis, MO
- NPI 1538113097
Pediatrics
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1237420800000",
"number": "1558468892",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11365 DORSETT RD.",
"city": "MARYLAND HEIGHTS",
"state": "MO",
"postal_code": "63043",
"telephone_number": "314-872-6430",
"fax_number": "314-872-6500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11365 DORSETT RD.",
"city": "MARYLAND HEIGHTS",
"state": "MO",
"postal_code": "63043",
"telephone_number": "314-872-6430",
"fax_number": "314-872-6500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMMONS",
"first_name": "CONNIE",
"middle_name": "D",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2009-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MO",
"license": "104168",
"primary": true
},
{
"code": "2080P0204X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Emergency Medicine",
"state": "MO",
"license": "104168",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "207648007",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Maryland Heights, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.