Active NPI
Rae Lynn Simmons
- Family Nurse Practitioner
- Salem, OR
National Provider Identifier
1942178058
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 0050882
- 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
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 |
|---|---|---|---|---|
| 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
Enrollment records 1
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
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
| License | State | Type | Specialty |
|---|---|---|---|
| 0050882 | OR | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clear Choice Dermatology | Current | 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2026; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.