Individual provider Active NPI

Emma Rae Simmons, ATC

  • Athletic Trainer
  • Williston, VT
National Provider Identifier
1700213246
Registry record updated Sep 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
License
104.0096670 Issued in VT
Practice address
426 Industrial Ave
Suite 190
Williston, VT 05495-4448
Phone
(802) 860-4360
NPI assigned
Sep 30, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 30, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X 104.0096670 VT Primary

Addresses

Primary practice location

426 Industrial Ave
Suite 190
Williston, VT 05495-4448

Mailing address

1195 North Ave
Apt. 404
Burlington, VT 05408-2772
Phone (802) 535-9415

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

State licenses

LicenseStateTypeSpecialty
104.0096670VTMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
PT 360 Inc Athletic Trainer PastSince Nov 22, 2010 Accepting new patients

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": "1380499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380499200000",
    "number": "1700213246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1195 NORTH AVE",
            "address_2": "APT. 404",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054082772",
            "telephone_number": "802-535-9415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "426 INDUSTRIAL AVE",
            "address_2": "SUITE 190",
            "city": "WILLISTON",
            "state": "VT",
            "postal_code": "054954448",
            "telephone_number": "802-860-4360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMMONS",
        "first_name": "EMMA",
        "middle_name": "RAE",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-09-30",
        "last_updated": "2013-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "VT",
            "license": "104.0096670",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williston, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2013; 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.