Simon Mark Clifford, MB BCH BAO

Primary specialty

Pediatric Radiology PhysicianTaxonomy code 2085P0229X

License

LT000880 Issued in PA

Practice address

3401 Civic Center Blvd
Philadelphia, PA 19104-4319

Phone

(215) 590-2584

NPI assigned

Oct 12, 2021

Last updated

Oct 12, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633996800000",
    "number": "1780346254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1815 JFK BLVD APT 1519",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191031713",
            "telephone_number": "215-821-4181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044319",
            "telephone_number": "215-590-2584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLIFFORD",
        "first_name": "SIMON",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "MB BCH BAO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-10-12",
        "last_updated": "2021-10-12",
        "certification_date": "2021-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085P0229X",
            "taxonomy_group": "",
            "desc": "Radiology, Pediatric Radiology",
            "state": "PA",
            "license": "LT000880",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cliffordsm@chop.edu",
            "affiliation": "N",
            "endpointDescription": "work email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3401 Civic Center Blvd",
            "city": "Philadelphia",
            "state": "PA",
            "country_code": "US",
            "postal_code": "191044319",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Honora Cleveland
• Melissa Clevenger, LMT
• Leah Sophia Cliatt, DO
• Clifford Yun Physical Therapy, PC
• Jay Clifford, PH.D.
• Celina Clifton, PA-C
• Joy N. Clifton, M.S.
• Lauren Pilar Cliggitt, LCSW
• Antonette Badua Climaco, M.D.
• Michael Douglas Cline, MD

• Pediatric Radiology Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Pediatric Radiology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2021; 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.