NPIMap

Individual provider Active NPI

Ryan Fred Simons, PA-C

  • Surgical Physician Assistant
  • Las Vegas, NV
National Provider Identifier
1902111792
Registry record updated Nov 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA1272 Issued in NV
Practice address
3012 S Durango Dr
Las Vegas, NV 89117-9186
Phone
(702) 835-0088
Fax
(702) 826-3162
NPI assigned
Aug 17, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Surgical Physician Assistant 363AS0400X PA1272 NV Primary

Addresses

Primary practice location

3012 S Durango Dr
Las Vegas, NV 89117-9186

Mailing address

3012 S Durango Dr
Las Vegas, NV 89117-9186
Phone (702) 835-0088

Other identifiers 2

IdentifierTypeStateIssuer
1902111792MedicaidNV
FF014ZOtherNVMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20110804000365 NV Practitioner - Physician Assistant 0547386708 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Garber Kaplan Douds PLLCGroup PAC ID 7911251806, 6 clinicians

Practice addresses (Care Compare)

3012 S Durango Dr
Las Vegas, NV 89117-9186
Phone (702) 835-0088

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA1272NVMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Spring Valley Medical Center Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 11

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

NPI Registry JSON

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

{
    "created_epoch": "1282003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605744000000",
    "number": "1902111792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3012 S DURANGO DR",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891179186",
            "telephone_number": "702-835-0088",
            "fax_number": "702-826-3162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3012 S DURANGO DR",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891179186",
            "telephone_number": "702-835-0088",
            "fax_number": "702-826-3162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMONS",
        "first_name": "RYAN",
        "middle_name": "FRED",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-17",
        "last_updated": "2020-11-19",
        "certification_date": "2020-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NV",
            "license": "PA1272",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1902111792",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE    PTAN",
            "identifier": "FF014Z",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.