Individual provider Active NPI

Mark Simon, M.D.

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1811078793
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Practice address
6300 N Ridge Ave
Chicago, IL 60660-1017
Phone
(773) 973-6300
NPI assigned
Oct 18, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X IL Primary

Addresses

Primary practice location

6300 N Ridge Ave
Chicago, IL 60660-1017

Mailing address

217 Kedzie St
Evanston, IL 60202-2405
Phone (847) 492-1847

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040415000014 IL Practitioner - Family Practice 7517952161 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-095934ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Erie Family Health Center Inc. CurrentSince Sep 22, 2015 Accepting new patients
Primecare Community Health, Inc. Family Medicine Current Accepting new patients
Primecare Community Health Inc. CurrentSince Aug 1, 2019 Accepting new patients
Erie Family Health Center Inc CurrentSince Sep 22, 2015 Accepting new patients
Primecare Community Health, Inc. Family Medicine Current Accepting new patients
Erie Family Health Center, Inc Current Accepting new patients
Primecare Community Health Inc CurrentSince Aug 1, 2019 Accepting new patients

Locations

1431 N Western Ave
Ste 406
Chicago, IL 60622
Phone (312) 491-5495

1504 S Albany Ave
Chicago, IL 60623

1701 W Superior St
Chicago, IL 60622
Phone (312) 432-7392

1701 W Superior St
Fl 3
Chicago, IL 60622
Phone (312) 432-2056

251 E Huron St
Chicago, IL 60611

5635 W Belmont Ave
Chicago, IL 60634
Phone (773) 736-1830

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811078793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 KEDZIE ST",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602022405",
            "telephone_number": "847-492-1847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6300 N RIDGE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606601017",
            "telephone_number": "773-973-6300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMON",
        "first_name": "MARK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.