Active NPI
Michael Wayne Simon, M.D.
- Pediatrics Physician
- Nicholasville, KY
National Provider Identifier
1992862205
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 22740
- Practice address
- 610 E Brannon Rd
Suite 201
Nicholasville, KY 40356-6066 - Phone
- (859) 277-6516
- Fax
- (859) 277-1521
- NPI assigned
- Jan 3, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 22740 | KY | Primary |
Addresses
Primary practice location
610 E Brannon Rd
Suite 201
Nicholasville, KY 40356-6066
Mailing address
610 E Brannon Rd
Suite 201
Nicholasville, KY 40356-6066
Phone (859) 277-6516
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64227408 | Medicaid | KY |
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.
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22740 | KY | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bluegrass Peds, PLLC | Pediatrics | Past | Accepting new patients |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365379200000",
"number": "1992862205",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "610 E BRANNON RD",
"address_2": "SUITE 201",
"city": "NICHOLASVILLE",
"state": "KY",
"postal_code": "403566066",
"telephone_number": "859-277-6516",
"fax_number": "859-277-1521"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "610 E BRANNON RD",
"address_2": "SUITE 201",
"city": "NICHOLASVILLE",
"state": "KY",
"postal_code": "403566066",
"telephone_number": "859-277-6516",
"fax_number": "859-277-1521"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMON",
"first_name": "MICHAEL",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-03",
"last_updated": "2013-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "KY",
"license": "22740",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64227408",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Nicholasville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.