Individual provider Active NPI

Ashley Kittles Simonak, D.O.

  • Diagnostic Radiology Physician
  • Charleston, SC
National Provider Identifier
1932337037
Registry record updated Jun 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
1274 Issued in SC
Practice address
171 Ashley Ave
Charleston, SC 29425-8908
Phone
(843) 792-1414
NPI assigned
Jun 26, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X LL1274 SC
Diagnostic Radiology Physician 2085R0202X 1274 SC Primary

Addresses

Primary practice location

171 Ashley Ave
Charleston, SC 29425-8908

Mailing address

PO Box 751461
Charlotte, NC 28275-1461
Phone (843) 792-6200

Other identifiers 1

IdentifierTypeStateIssuer
LL1274OtherSCLIMITED LICENSE NUMBER

Other names 1

  • Ashley Marie Kittles Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20150916002875 TX Practitioner - Diagnostic Radiology 3577781103 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of North Texas HSC, College of Osteopathic Med, 2009
Medicare assignment
May accept Medicare assignment
Group practices
Radiology Associates of North Texas PAGroup PAC ID 7911897301, 340 clinicians

Practice addresses (Care Compare)

815 Pennsylvania Ave
Fort Worth, TX 76104-2224
Phone (817) 321-0470

Hospital & facility affiliations

  • Baylor Scott & White Medical Center at Irving Hospital, Irving, TX, CCN 450079

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
LL1274SCMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Stone JV LLP CurrentSince Nov 25, 2021 Accepting new patients
Radiology Associates of North Texas PA Diagnostic Radiology CurrentSince Jul 21, 2023 Accepting new patients
Clinical Care in Radiology Current Accepting new patients
Radiology Associates of North Texas PA Diagnostic Radiology CurrentSince Jul 21, 2023 Accepting new patients

Locations

17980 Dallas Pkwy
Ste 200
Dallas, TX 75287
Phone (972) 248-1303

815 Pennsylvania Ave
Ft Worth, TX 76104
Phone (817) 321-0300

816 W Cannon St
Ft Worth, TX 76104
Phone (817) 321-0312

1901 N MacArthur Blvd
Irving, TX 75061
Phone (972) 484-5192

2120 N MacArthur Blvd
Ste 100
Irving, TX 75061
Phone (972) 438-4636

Organizations & group practices 4

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 2

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": "1245974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403481600000",
    "number": "1932337037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751461",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751461",
            "telephone_number": "843-792-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 ASHLEY AVE",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294258908",
            "telephone_number": "843-792-1414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMONAK",
        "first_name": "ASHLEY",
        "middle_name": "KITTLES",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-26",
        "last_updated": "2014-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "SC",
            "license": "LL1274",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "SC",
            "license": "1274",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LIMITED LICENSE NUMBER",
            "identifier": "LL1274",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ASHLEY",
            "last_name": "KITTLES",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.