NPIMap

Individual provider Active NPI

Marcus L Simmons, MD

  • Internal Medicine Physician
  • Macon, GA
National Provider Identifier
1770511180
Registry record updated Dec 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
049946 Issued in GA
Practice address
5569 Houston Rd
Macon, GA 31216-5709
Phone
(478) 781-5065
Fax
(478) 781-0012
NPI assigned
Jun 28, 2006
Last updated
Dec 13, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 049946 GA Primary

Addresses

Primary practice location

5569 Houston Rd
Macon, GA 31216-5709

Mailing address

5569 Houston Rd
Macon, GA 31216-5709
Phone (478) 781-5065

Other identifiers 3

IdentifierTypeStateIssuer
000863475CMedicaidGA
00863475BMedicaidGA
202167625OtherGAFEDERAL TAX ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040622001399 GA Practitioner - Internal Medicine 5496730566 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Medical College of Georgia School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians
Rutland Family Healthcare LLCGroup PAC ID 0244286151, 2 clinicians

Practice addresses (Care Compare)

2600 Compass Rd
Glenview, IL 60026-8001

5569 Houston Rd
Macon, GA 31216-5709
Phone (478) 781-5065

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
049946GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rutland Family Healthcare LLC Internal Medicine CurrentSince Feb 1, 2005 Accepting new patients
Physicians Care Center LLC Internal Medicine Past Accepting new patients
Ut Physicians Inc Internal Medicine Past Accepting new patients

Locations

4226 Hartley Bridge Rd
Ste 104
Macon, GA 31216
Phone (478) 781-5065

5569 Houston Rd
Macon, GA 31216
Phone (478) 781-5065

Organizations & group practices 4

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 8

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": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481587200000",
    "number": "1770511180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5569 HOUSTON RD",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312165709",
            "telephone_number": "478-781-5065",
            "fax_number": "478-781-0012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5569 HOUSTON RD",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312165709",
            "telephone_number": "478-781-5065",
            "fax_number": "478-781-0012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMMONS",
        "first_name": "MARCUS",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2016-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "049946",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000863475C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00863475B",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL TAX ID",
            "identifier": "202167625",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

Verify at the official NPI Registry.