Individual provider Active NPI

Steven Boe Simmons, PA-C

  • Physician Assistant
  • Pocatello, ID
National Provider Identifier
1740212190
Registry record updated Apr 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-272 Issued in ID
Practice address
2240 E Center St
Pocatello, ID 83201-2600
Phone
(208) 233-2100
Fax
(208) 233-3146
NPI assigned
Jul 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA-272 ID Primary

Addresses

Primary practice location

2240 E Center St
Pocatello, ID 83201-2600

Mailing address

2240 E Center St
Pocatello, ID 83201-2600
Phone (208) 233-2100

Other identifiers 1

IdentifierTypeStateIssuer
805765100MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060125000634 ID Practitioner - Physician Assistant 6406870765 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Pocatello Health Services LLCGroup PAC ID 6608927637, 171 clinicians

Practice addresses (Care Compare)

2240 E Ctr St
Pocatello, ID 83201-2600
Phone (208) 233-2100

777 Hospital Way
Pocatello, ID 83201-5175

Hospital & facility affiliations

  • Portneuf Medical Center Hospital, Pocatello, ID, CCN 130028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Pocatello Health Services, LLC CurrentSince Jan 1, 2022 Accepting new patients
Dr. Farrell, LLC Past Accepting new patients
Pocatello Hospital LLC Past Accepting new patients
Intermountain Neurosurgery, P.a. Neurological Surgery Past Accepting new patients

Locations

777 Hospital Way
Pocatello, ID 83201
Phone (208) 239-1000

777 Hospital Way
Ste 202
Pocatello, ID 83201
Phone (208) 239-2640

333 N 18th Ave
Ste D1
Pocatello, ID 83201
Phone (208) 233-2100

2240 E Center St
Pocatello, ID 83201
Phone (208) 233-2100

Interoperability endpoints

  • Direct secure messaging: ssimmons262015@ahs.direct-ci.com
  • Direct secure messaging: bsimmons@direct.orthoida.com

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523232000000",
    "number": "1740212190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2240 E CENTER ST",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012600",
            "telephone_number": "208-233-2100",
            "fax_number": "208-233-3146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2240 E CENTER ST",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012600",
            "telephone_number": "208-233-2100",
            "fax_number": "208-233-3146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMMONS",
        "first_name": "STEVEN",
        "middle_name": "BOE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2018-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-272",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805765100",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

Verify at the official NPI Registry.