Emily Marie Simon, CNM

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085009726 Issued in IL

Practice address

208 Parker St
Boscobel, WI 53805-1648

Phone

(608) 375-2424

NPI assigned

Aug 2, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Emily Marie McCullick Former name

Medicare fee-for-service enrollment

Enrolled in IL

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

Specialty

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Saint Anthony Medical CenterGroup PAC ID 5496654006, 45 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Anthony Medical Center Hospital, Rockford, IL, CCN 140233

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife, Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: emccullick473392@direct.emplifyhealth.org

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.

• Saint Anthony Medical Center

  • Hematology & Oncology Physician
  • Rockford, IL
  • NPI 1942248802
  Medicare reassignment Care Compare group
• Osf Multi-Specialty Group

  • Internal Medicine Physician
  • Peoria, IL
  • NPI 1922445527
  Medicare reassignment NPD
• Central PA Pharmacy LLC.

  • Community/Retail Pharmacy
  • Patton, PA
  • NPI 1578541413
  NPD
• Saint Anthony Medical Center

  • Surgical Oncology Physician
  • Rockford, IL
  • NPI 1235349036
  NPD
• Saint Anthony Medical Center

  • Rural Health Clinic/Center
  • Loves Park, IL
  • NPI 1558067975
  NPD
• Saint Anthony Medical Center

  • General Acute Care Hospital
  • Rockford, IL
  • NPI 1790739977
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Saint Anthony Medical Center

  • General Acute Care Hospital
  • Rockford, IL
  • NPI 1790739977
  Care Compare affiliation

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

{
    "created_epoch": "1596326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709078400000",
    "number": "1992315238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 PARKER ST",
            "city": "BOSCOBEL",
            "state": "WI",
            "postal_code": "538051648",
            "telephone_number": "608-375-2424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 PARKER ST",
            "city": "BOSCOBEL",
            "state": "WI",
            "postal_code": "538051648",
            "telephone_number": "608-375-2424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMON",
        "first_name": "EMILY",
        "middle_name": "MARIE",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-02",
        "last_updated": "2024-02-28",
        "certification_date": "2024-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WI",
            "license": "5155",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085009726",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EMILY",
            "last_name": "MCCULLICK",
            "middle_name": "MARIE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• School District of Boscobel Area Schools
• Patrick Joseph Schweiger, MD
• Senior Management Inc
• Trudy Sheedy, OT
• Tammy Shepherd
• Kimberly Lynn Skinner, PT
• Jared Snyder
• Alison Spany, CPM
• St. Marys Dean Ventures Inc.
• Ashley Nicole Stanek, RCEP

• Physician Assistant in Boscobel, WI
• Providers in Boscobel, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2024; 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.

Verify at the official NPI Registry.