NPIMap

Individual provider Active NPI

Simone Keisha Guest, D.O

  • Family Medicine Physician
  • Bay Shore, NY
National Provider Identifier
1558598177
Registry record updated May 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
274346124 Issued in NY
Practice address
8 Maple Ave
Bay Shore, NY 11706-8722
Phone
(631) 665-4392
Fax
(631) 665-5008
NPI assigned
Jun 22, 2009
Last updated
May 21, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 274346124 NY Primary

Addresses

Primary practice location

8 Maple Ave
Bay Shore, NY 11706-8722

Mailing address

PO Box 14890
Albany, NY 12212-4890
Phone (518) 525-5634

Other practice location 1

1375 Washington Ave Ste 202
Albany, NY 12206-1056
Phone (518) 482-0007

Other names 1

  • Simone Keisha Davis Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address payer.credentialing@sphp.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121219000483 NY Practitioner - Family Practice 9436301447 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
New York College of Osteo Medicine of New York Institute of Technology, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1375 Washington Ave
Suite 202
Albany, NY 12206-1056
Phone (518) 482-0007

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
274346124NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Patchogue Family Medical Care, PC Family Medicine CurrentSince Apr 21, 2014 Accepting new patients
St. Peter's Health Partners Medical Associates, P.C. Family Medicine CurrentSince Jun 1, 2016 Accepting new patients
St. Peter's Health Partners Medical Associates, P.C. Past Accepting new patients

Locations

1375 Washington Ave
Ste 202
Albany, NY 12206
Phone (518) 482-0007

130 Medford Ave
Patchogue, NY 11772
Phone (631) 475-5734

2 New Hampshire Ave
Troy, NY 12180
Phone (518) 272-0331

Interoperability endpoints

  • Direct secure messaging: sguest789018@direct.trinity-health.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1245628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621555200000",
    "number": "1558598177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14890",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122124890",
            "telephone_number": "518-525-5634",
            "fax_number": "518-649-4094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 MAPLE AVE",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117068722",
            "telephone_number": "631-665-4392",
            "fax_number": "631-665-5008"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1375 Washington Ave Ste 202",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "NY",
            "postal_code": "122061056",
            "country_code": "US",
            "telephone_number": "518-482-0007",
            "fax_number": "518-482-0008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUEST",
        "first_name": "SIMONE",
        "middle_name": "KEISHA",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-22",
        "last_updated": "2021-05-21",
        "certification_date": "2021-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "274346124",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "payer.credentialing@sphp.com",
            "affiliation": "N",
            "endpointDescription": "SPHP Payer Credentialing",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1375 Washington Ave Ste 202",
            "city": "Albany",
            "state": "NY",
            "country_code": "US",
            "postal_code": "122061056",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SIMONE",
            "last_name": "DAVIS",
            "middle_name": "KEISHA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Bay Shore, NY

Sources for this page

Verify at the official NPI Registry.