Individual provider Active NPI

Andrea Simms, M.D.

  • Student in an Organized Health Care Education/Training Program
  • Stony Brook, NY
National Provider Identifier
1669850657
Registry record updated May 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
Stony Brook Hospital Department of Emergency
HSC Level 4 Room 080
Stony Brook, NY 11794-8350
Phone
(631) 444-3880
Fax
(631) 444-3919
NPI assigned
May 11, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

Stony Brook Hospital Department of Emergency
HSC Level 4 Room 080
Stony Brook, NY 11794-8350

Mailing address

11 Chivalry LN
Nesconset, NY 11767-2034
Phone (540) 840-5099

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20181030000776 VA Practitioner - Emergency Medicine 1658624283 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
97.87 of 100Reported as group
Quality
95.04
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Observation Physicians of Tidewater CurrentSince Aug 1, 2022 Accepting new patients

Locations

2800 Godwin Blvd
Suffolk, VA 23434
Phone (757) 363-6850

Organizations & group practices 1

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": "1431302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431302400000",
    "number": "1669850657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 CHIVALRY LN",
            "city": "NESCONSET",
            "state": "NY",
            "postal_code": "117672034",
            "telephone_number": "540-840-5099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "STONY BROOK HOSPITAL DEPARTMENT OF EMERGENCY",
            "address_2": "HSC LEVEL 4 ROOM 080",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117948350",
            "telephone_number": "631-444-3880",
            "fax_number": "631-444-3919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMMS",
        "first_name": "ANDREA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-11",
        "last_updated": "2015-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

Verify at the official NPI Registry.