Mackenzie Simon, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

4388 Issued in AR

Practice address

1308 Military Rd
Benton, AR 72015-2911

Phone

(501) 778-4960

Fax

(501) 778-4968

NPI assigned

Sep 7, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pro Active Rehab, IncGroup PAC ID 2668482340, 15 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Pro Active Rehab, Inc

  • Physical Therapist
  • Benton, AR
  • NPI 1215021159
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1504742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518739200000",
    "number": "1952829285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1890",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720181890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1308 MILITARY RD",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720152911",
            "telephone_number": "501-778-4960",
            "fax_number": "501-778-4968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMON",
        "first_name": "MACKENZIE",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-07",
        "last_updated": "2018-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AR",
            "license": "4388",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Henry Simmons, M.D.
• Jake Simmons, CMP
• James Aaron Simmons, MD
• Julia Simmons, RECOVERY ASSISTANT
• Russell Thomas Simmons, O.D.
• Tiffany Marie Simpson, OTR/L
• Abby G Sims, MS, CCC-SLP
• Kormyn Shay Sims
• Morgan Sims
• Jai Singkhek

• Physical Therapist in Benton, AR
• Providers in Benton, AR by specialty
• Physical Therapist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.