Individual provider Active NPI

Rae Lynn Simmons

  • Family Nurse Practitioner
  • Salem, OR
National Provider Identifier
1942178058
Registry record updated Mar 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0050882 Issued in OR
Practice address
966 12TH St SE Ste 130
Salem, OR 97302-2860
Phone
(503) 837-6395
NPI assigned
Oct 29, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0050882 OR Primary

Addresses

Primary practice location

966 12TH St SE Ste 130
Salem, OR 97302-2860

Mailing address

966 12TH St SE Ste 130
Salem, OR 97302-2860

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260417002475 OR Practitioner - Nurse Practitioner 7810463718 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clear Choice DermatologyGroup PAC ID 4789005034, 47 clinicians

Practice addresses (Care Compare)

966 12TH St SE
Suite 130
Salem, OR 97302-2860
Phone (503) 837-6395

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0050882ORMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Clear Choice Dermatology CurrentSince Mar 2, 2026 Accepting new patients

Locations

123 C Ave
Lake Oswego, OR 97034
Phone (702) 550-9784

966 12th St SE
Ste 130
Salem, OR 97302
Phone (503) 540-7477

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1761696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774483200000",
    "number": "1942178058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "966 12TH ST SE STE 130",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973022860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "966 12TH ST SE STE 130",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973022860",
            "telephone_number": "503-837-6395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMMONS",
        "first_name": "RAE",
        "middle_name": "LYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-10-29",
        "last_updated": "2026-03-26",
        "certification_date": "2026-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "0050882",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

Verify at the official NPI Registry.