NPIMap

Individual provider Active NPI

Kelli Jo Simco, PA-C

  • Physician Assistant
  • State College, PA
National Provider Identifier
1811345416
Registry record updated Aug 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA058257 Issued in PA
Practice address
200 Scenery Dr
State College, PA 16801-7974
Phone
(814) 231-4560
Fax
(814) 231-6246
NPI assigned
May 25, 2016
Last updated
Aug 31, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2020

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 MA058257 PA Primary

Addresses

Primary practice location

200 Scenery Dr
State College, PA 16801-7974

Mailing address

100 N Academy Ave
Danville, PA 17822-4903
Phone (570) 271-6144

Other practice location 1

224 North Logan Blvd., Ste. 220
Burnham, PA 17009-4510
Phone (717) 242-0196

Other names 1

  • Kelli Jo Fohringer Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ksimco138937@direct.geisinger.edu Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20160819000990 PA Practitioner - Physician Assistant 4284929993 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

32 Colonnade Way
State College, PA 16803-2309
Phone (814) 272-4445

500 Universidy Dr
Hershey, PA 17033-2360

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger-HM Joint Venture, LLC Physician Assistant CurrentSince Mar 4, 2020 Accepting new patients
The Milton S Hershey Medical Center Physician Group CurrentSince Nov 1, 2022 Accepting new patients
Geisinger Clinic Physician Assistant CurrentSince Mar 5, 2018 Accepting new patients
The Milton S Hershey Medical Center Physician Group CurrentSince Nov 1, 2022 Accepting new patients
Geisinger Clinic CurrentSince Mar 5, 2018 Accepting new patients
Geisinger-HM Joint Venture, LLC CurrentSince Mar 4, 2020 Accepting new patients
The Milton S. Hershey Medical Center Physicians Group Past Accepting new patients

Locations

224 N Logan Blvd
Ste 220
Burnham, PA 17009
Phone (717) 242-0196

100 N Academy Ave
Danville, PA 17822

500 University Dr
#A4
Hershey, PA 17033
Phone (717) 531-6261

10 Choate Cir
Montoursville, PA 17754
Phone (570) 368-5566

155 Wellness Way
State College, PA 16803
Phone (800) 367-0179

200 Scenery Dr
State College, PA 16801
Phone (814) 231-4560

32 Colonnade Way
State College, PA 16803
Phone (717) 531-5164

611 University Dr
State College, PA 16801
Phone (814) 234-2600

Interoperability endpoints

  • Direct secure messaging: ksimco138937@direct.geisinger.edu

Organizations & group practices 10

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 18

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1464134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598832000000",
    "number": "1811345416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178224903",
            "telephone_number": "570-271-6144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 SCENERY DR",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168017974",
            "telephone_number": "814-231-4560",
            "fax_number": "814-231-6246"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "224 North Logan Blvd., Ste. 220",
            "address_purpose": "LOCATION",
            "city": "Burnham",
            "state": "PA",
            "postal_code": "170094510",
            "country_code": "US",
            "telephone_number": "717-242-0196",
            "fax_number": "717-242-0701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIMCO",
        "first_name": "KELLI",
        "middle_name": "JO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-25",
        "last_updated": "2020-08-31",
        "certification_date": "2020-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA058257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ksimco138937@direct.geisinger.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "200 Scenery Dr",
            "city": "State College",
            "state": "PA",
            "country_code": "US",
            "postal_code": "168017974",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KELLI",
            "last_name": "FOHRINGER",
            "middle_name": "JO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in State College, PA

Sources for this page

Verify at the official NPI Registry.