Individual provider Active NPI

Shannon Simmons

  • Gastroenterology Physician
  • Providence, RI
National Provider Identifier
1619210630
Registry record updated Dec 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
MD16784 Issued in RI
Practice address
593 Eddy St
Apc 406
Providence, RI 02903-4923
Phone
(401) 444-5031
NPI assigned
Mar 27, 2013
Last updated
Dec 28, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 28, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Gastroenterology Physician 207RG0100X MD16784 RI Primary

Addresses

Primary practice location

593 Eddy St
Apc 406
Providence, RI 02903-4923

Mailing address

593 Eddy St
Apc 406
Providence, RI 02903-4923
Phone (401) 444-5031

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
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
I20190823001293 RI Practitioner - Gastroenterology 3678705738 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Warren Alpert Medical School of Brown University, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifespan Physician Group IncGroup PAC ID 2567455082, 1,151 clinicians

Practice addresses (Care Compare)

950 Warren Ave
Suite 302
East Providence, RI 02914-1432
Phone (401) 444-6551

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy32
Upper gastrointestinal (GI) endoscopy for acid reflux36

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Rhode Island Hospital CurrentSince Aug 11, 2022 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Sep 1, 2019 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Sep 1, 2019 Accepting new patients
Rhode Island Hospital CurrentSince Aug 11, 2022 Accepting new patients
Lifespan Physician Group, Inc. Past Accepting new patients

Locations

1500 Pontiac Ave
Ste 101
Cranston, RI 02920
Phone (401) 371-0223

1454 S County Trl
Ste 2100
East Greenwich, RI 02818
Phone (401) 606-2000

950 Warren Ave
Ste 301
East Providence, RI 02914
Phone (401) 444-3611

950 Warren Ave
Ste 302
East Providence, RI 02914
Phone (401) 444-2701

185A High Service Ave
North Providence, RI 02904
Phone (401) 354-6050

117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318

245 Chapman St
Ste 300
Providence, RI 02905
Phone (401) 444-4741

593 Eddy St
Providence, RI 02903

593 Eddy St
#406
Providence, RI 02903
Phone (401) 444-5031

593 Eddy St
Ste 9B
Providence, RI 02903
Phone (401) 444-5280

62 Amaral St
Riverside, RI 02915
Phone (401) 649-4030

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 5

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": "1364342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672185600000",
    "number": "1619210630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "address_2": "APC 406",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "401-444-5031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "address_2": "APC 406",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "401-444-5031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMMONS",
        "first_name": "SHANNON",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-03-27",
        "last_updated": "2022-12-28",
        "certification_date": "2022-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "RI",
            "license": "MD16784",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.