NPIMap

Individual provider Active NPI

Simeon A Melaku, D.O

  • Family Medicine Physician
  • Rockwall, TX
National Provider Identifier
1609300870
Registry record updated Mar 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
W2320 Issued in TX
Practice address
2265 N Lakeshore Dr Ste 101
Rockwall, TX 75087-3210
Phone
(972) 771-2500
Fax
(972) 722-4550
NPI assigned
Apr 14, 2017
Last updated
Mar 17, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0102206269 VA
Family Medicine Physician 207Q00000X W2320 TX Primary
Obesity Medicine (Internal Medicine) Physician 207RB0002X W2320 TX

Addresses

Primary practice location

2265 N Lakeshore Dr Ste 101
Rockwall, TX 75087-3210

Mailing address

PO Box 748613
Atlanta, GA 30374-8613

Other practice location 1

1015 Spring Creek Pkwy
Zion Crossroads, VA 22942-7019
Phone (434) 243-9466

Other identifiers 1

IdentifierTypeStateIssuer
1609300870MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20201014000751 VA Practitioner - Family Practice 5193145159 Reassigns benefits to 1 organization
I20260324001865 TX Practitioner - Family PracticePractitioner - Internal Medicine 5193145159 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Edward Via Col of Osteo Medicine-Carolinas Campus, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Texas Health Physicians GroupGroup PAC ID 4385535954, 1,364 clinicians
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians

Practice addresses (Care Compare)

15195 Heathcote Blvd
Suite 150
Haymarket, VA 20169-6243
Phone (571) 284-1430

2265 N Lakeshore Dr
Suite 101
Rockwall, TX 75087-3210
Phone (972) 771-2500

2600 Compass Rd
Glenview, IL 60026-8001

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
W2320TXMDFamily Medicine Physician
0102206269VAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Uva Community Health Medical Group, LLC CurrentSince Mar 1, 2023 Accepting new patients
Uva Community Health Medical Group, LLC CurrentSince Mar 1, 2023 Accepting new patients
Uva Community Health Medical Group, LLC Family Medicine Past Accepting new patients

Locations

4105 Lewis and Clark Dr
Charlottesvle, VA 22911

15195 Heathcote Blvd
Ste 150
Haymarket, VA 20169
Phone (571) 284-1430

Interoperability endpoints

  • Direct secure messaging: smelaku554590@direct.healthsystem.virginia.edu

Organizations & group practices 5

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 12

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": "1492128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773705600000",
    "number": "1609300870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 748613",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303748613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2265 N LAKESHORE DR STE 101",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "750873210",
            "telephone_number": "972-771-2500",
            "fax_number": "972-722-4550"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1015 Spring Creek Pkwy",
            "address_purpose": "LOCATION",
            "city": "Zion Crossroads",
            "state": "VA",
            "postal_code": "229427019",
            "country_code": "US",
            "telephone_number": "434-243-9466",
            "fax_number": "434-243-9499",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MELAKU",
        "first_name": "SIMEON",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-14",
        "last_updated": "2026-03-17",
        "certification_date": "2026-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0102206269",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "W2320",
            "primary": true
        },
        {
            "code": "207RB0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Obesity Medicine",
            "state": "TX",
            "license": "W2320",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1609300870",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockwall, TX

Sources for this page

Verify at the official NPI Registry.