Active NPI
Jack Simon, M.D.
- Psychiatry Physician
- Los Altos, CA
National Provider Identifier
1861694135
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- G19513
- Practice address
- 164 Main St
Los Altos, CA 94022-2928 - Phone
- (650) 941-6670
- Fax
- (650) 949-1262
- NPI assigned
- May 31, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | G19513 | CA | Primary |
Addresses
Primary practice location
164 Main St
Los Altos, CA 94022-2928
Mailing address
164 Main St.
Los Altos, CA 94022
Phone (650) 941-6670
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 3, 2015 through Oct 3, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1861694135",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "164 MAIN ST.",
"city": "LOS ALTOS",
"state": "CA",
"postal_code": "94022",
"telephone_number": "650-941-6670",
"fax_number": "650-949-1262"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "164 MAIN ST",
"city": "LOS ALTOS",
"state": "CA",
"postal_code": "940222928",
"telephone_number": "650-941-6670",
"fax_number": "650-949-1262"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMON",
"first_name": "JACK",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-31",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "G19513",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Altos, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.