Active NPI
Connie Lee Simons, PSYD RN
- Psychologist
- Niles, IL
National Provider Identifier
1700964673
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 071006844
- Practice address
- 241 Golf Mill Center
#602
Niles, IL 60714 - Phone
- (847) 390-0776
- Fax
- (847) 390-7625
- NPI assigned
- Nov 1, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 071006844 | IL | Primary |
Addresses
Primary practice location
241 Golf Mill Center
#602
Niles, IL 60714
Mailing address
241 Golf Mill Center
#602
Niles, IL 60714
Phone (847) 390-0776
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 364467571 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050427000297 | IL | Practitioner - Clinical Psychologist | 2264471507 | Practice locations: Evanston, IL; Niles, IL |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
241 Golf Mill Ctr
Suite 328
Niles, IL 60714-1215
Phone (847) 525-0259
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy, Registered Nurse
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588896000000",
"number": "1700964673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "241 GOLF MILL CENTER",
"address_2": "#602",
"city": "NILES",
"state": "IL",
"postal_code": "60714",
"telephone_number": "847-390-0776",
"fax_number": "847-390-7625"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "241 GOLF MILL CENTER",
"address_2": "#602",
"city": "NILES",
"state": "IL",
"postal_code": "60714",
"telephone_number": "847-390-0776",
"fax_number": "847-390-7625"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMONS",
"first_name": "CONNIE",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "PSYD RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-01",
"last_updated": "2020-05-08",
"certification_date": "2020-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "IL",
"license": "071006844",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "364467571",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Niles, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.