Individual provider Active NPI

Scott Eddy Semones, NP

  • Pediatric Nurse Practitioner
  • Delta, CO
National Provider Identifier
1619200615
Registry record updated Feb 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
SNP-20006 Issued in CO
Practice address
360 E 8TH St
Delta, CO 81416-2379
Phone
(970) 874-2753
Fax
(970) 874-2943
NPI assigned
Sep 9, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X SNP-20006 CO Primary

Addresses

Primary practice location

360 E 8TH St
Delta, CO 81416-2379

Mailing address

360 E 8TH St
Delta, CO 81416-2379
Phone (970) 874-2753

Other identifiers 1

IdentifierTypeStateIssuer
57281289MedicaidCO

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)
Not enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
SNP-20006COMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
A Kidz Clinic Past Accepting new patients
A Kidz Clinic PastSince Jun 16, 2024 Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1252454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739318400000",
    "number": "1619200615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 E 8TH ST",
            "city": "DELTA",
            "state": "CO",
            "postal_code": "814162379",
            "telephone_number": "970-874-2753",
            "fax_number": "970-874-2943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 E 8TH ST",
            "city": "DELTA",
            "state": "CO",
            "postal_code": "814162379",
            "telephone_number": "970-874-2753",
            "fax_number": "970-874-2943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEMONES",
        "first_name": "SCOTT",
        "middle_name": "EDDY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-09",
        "last_updated": "2025-02-12",
        "certification_date": "2025-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CO",
            "license": "SNP-20006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "57281289",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Delta, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.