Individual provider Active NPI

Mark J Simone-Skidmore, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Philadelphia, PA
National Provider Identifier
1568681609
Registry record updated Nov 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
MD464838 Issued in PA
Practice address
3615 Chestnut St
Philadelphia, PA 19104-2612
Phone
(215) 662-2746
Fax
(215) 349-5648
NPI assigned
Apr 25, 2007
Last updated
Nov 4, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 231612 MA
Geriatric Medicine (Internal Medicine) Physician 207RG0300X MD464838 PA Primary

Addresses

Primary practice location

3615 Chestnut St
Philadelphia, PA 19104-2612

Mailing address

3615 Chestnut St
Philadelphia, PA 19104-2612
Phone (215) 866-8904

Other names 1

  • Dr. Mark J Simone Professional name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180924002501 PA Practitioner - Geriatric Medicine 5395812564 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Geriatric Medicine
Education
Jefferson Medical College of Thomas Jefferson University, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

250 King of Prussia Rd
Radnor, PA 19087-5227
Phone (610) 902-5600

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
231612MAMDGeriatric Medicine (Internal Medicine) Physician
MD464838PAMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn - Medical Group Geriatric Medicine CurrentSince Oct 1, 2018 Accepting new patients
Clinical Care Associates of the University of Pennsylvania Health CurrentSince Oct 4, 2021 Accepting new patients
University of Penn-Medical Group CurrentSince Oct 1, 2018 Accepting new patients
Clinical Care Associates of the University of Pennsylvania Health CurrentSince Oct 4, 2021 Accepting new patients
University of Penn - Medical Group Past Accepting new patients
Presbyterian Medical Center of the University of Pennsylvania Health S Past Accepting new patients

Locations

3615 Chestnut St
Philadelphia, PA 19104
Phone (215) 662-2746

3624 Market St
Fl 2
Philadelphia, PA 19104
Phone (215) 615-3669

800 Spruce St
Fl 1
Philadelphia, PA 19107
Phone (215) 829-5873

250 King of Prussia Rd
Radnor, PA 19087
Phone (610) 902-1800

777 Township Line Rd
Ste 200
Yardley, PA 19067
Phone (215) 860-0775

Organizations & group practices 6

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 4

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": "1177459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635984000000",
    "number": "1568681609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3615 CHESTNUT ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191042612",
            "telephone_number": "215-866-8904",
            "fax_number": "914-306-8247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3615 CHESTNUT ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191042612",
            "telephone_number": "215-662-2746",
            "fax_number": "215-349-5648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMONE-SKIDMORE",
        "first_name": "MARK",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-25",
        "last_updated": "2021-11-04",
        "certification_date": "2021-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "MA",
            "license": "231612",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "PA",
            "license": "MD464838",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARK",
            "last_name": "SIMONE",
            "middle_name": "J",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.