Individual provider Active NPI

Jennifer Jane Lee Simon, APRN

  • Family Nurse Practitioner
  • Missoula, MT
National Provider Identifier
1992161772
Registry record updated Jan 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
NUR-APRN-LIC-101975 Issued in MT
Practice address
500 W Broadway St Ste 310
Missoula, MT 59802-4003
Phone
(406) 546-2042
Fax
(406) 329-2799
NPI assigned
Jan 8, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2016

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 NUR-APRN-LIC-101975 MT Primary

Addresses

Primary practice location

500 W Broadway St Ste 310
Missoula, MT 59802-4003

Mailing address

500 W Broadway St Ste 310
Missoula, MT 59802-4003
Phone (406) 546-2042

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT
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
I20160210001319 MT Practitioner - Nurse Practitioner 9931403011 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Health and Services MtGroup PAC ID 6608786306, 358 clinicians

Practice addresses (Care Compare)

500 W Broadway St
Suite 310
Missoula, MT 59802-4003
Phone (406) 728-6520

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NUR-APRN-LIC-101975MTMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Mt CurrentSince Feb 1, 2016 Accepting new patients
Providence Health & Services Mt Current Accepting new patients
Providence Health & Services Mt CurrentSince Feb 1, 2016 Accepting new patients

Locations

500 W Broadway St
Ste 310
Missoula, MT 59802
Phone (406) 728-6520

500 W Broadway St
Missoula, MT 59802
Phone (406) 327-1918

500 W Broadway St
Ste 320
Missoula, MT 59802
Phone (406) 329-2945

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 5

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": "1452211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452211200000",
    "number": "1992161772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W BROADWAY ST STE 310",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024003",
            "telephone_number": "406-546-2042",
            "fax_number": "406-329-2799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W BROADWAY ST STE 310",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024003",
            "telephone_number": "406-546-2042",
            "fax_number": "406-329-2799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMON",
        "first_name": "JENNIFER",
        "middle_name": "JANE LEE",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-08",
        "last_updated": "2016-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MT",
            "license": "NUR-APRN-LIC-101975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.