Active NPI
John Childs Simpson, 111, PH.D.
- Psychologist
- Charlotte, NC
National Provider Identifier
1871534065
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 0745
- Practice address
- 121 Greenwich Rd
Suite 215
Charlotte, NC 28211-2355 - Phone
- (704) 362-7007
- Fax
- (704) 362-7007
- NPI assigned
- Jun 9, 2006
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 0745 | NC | Primary |
Addresses
Primary practice location
121 Greenwich Rd
Suite 215
Charlotte, NC 28211-2355
Mailing address
121 Greenwich Rd
Suite 215
Charlotte, NC 28211-2355
Phone (704) 362-7007
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04674 | Other | NC | BLUE CROSS BLUE SHIELD |
| 6001077 | Medicaid | NC |
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: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0745 | NC | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257379200000",
"number": "1871534065",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "121 GREENWICH RD",
"address_2": "SUITE 215",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282112355",
"telephone_number": "704-362-7007",
"fax_number": "704-362-7007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "121 GREENWICH RD",
"address_2": "SUITE 215",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282112355",
"telephone_number": "704-362-7007",
"fax_number": "704-362-7007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMPSON, 111",
"first_name": "JOHN",
"middle_name": "CHILDS",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-09",
"last_updated": "2009-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NC",
"license": "0745",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "04674",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6001077",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2009; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.