DR. GEORGE RAJAN SIMON MD
NPI 1164438768
Internal Medicine - Medical Oncology in Celebration, FL


Quality Rating: 94.68 out of 100 score

NPI Status: Active since August 01, 2006

Contact Information

380 CELEBRATION PL FL 2
CELEBRATION, FL
ZIP 34747
Phone: (843) 792-1414

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  • Individual
  • Male
  • Years of Experience 39
  • Internal Medicine
  • Medical Oncology
  • PECOS Enrolled
  • Accepts Medicare Approved Payment

About GEORGE SIMON

George Simon is an internist established in Celebration, Florida and his medical specialization is Internal Medicine with a focus in medical oncology with more than 39 years of experience. The healthcare provider is registered in the NPI registry with number 1164438768 assigned on August 2006. The practitioner's primary taxonomy code is 207RX0202X with license number ME83970 (FL). The provider is registered as an individual and his NPI record was last updated 4 years ago.

NPI
1164438768
Provider Name
DR. GEORGE RAJAN SIMON MD
Other Name
DR. GEORGE RAJAN MD
Other Name Type
Former Name (1)
Gender
Male
Entity Type
Individual
Location Address
380 CELEBRATION PL FL 2 CELEBRATION, FL 34747
Location Phone
(843) 792-1414
Mailing Address
380 CELEBRATION PL FL 2 CELEBRATION, FL 34747
Medical School Name
OTHER
Graduation Year
1986
Is Sole Proprietor?
No
Enumeration Date
08-01-2006
Last Update Date
09-18-2020
Code Navigator

An internist like George Simon is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.

George Simon is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.

The provider participated in CMS Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 94.68, based on four performance areas: quality, improvement activities, promoting interoperability, and cost. The purpose of this information is to help people with Medicare make informed decisions and incentivize doctors and clinicians to maximize performance.

The typical physician office visit costs for Medicare beneficiaries in this area are: $44.69 for a new patient copayment and $25.94 for an established patient copayment.

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Internal Medicine Medical Oncology

Taxonomy Code
207RX0202X
Type
Allopathic & Osteopathic Physicians
License No.
ME83970
License State
FL
Taxonomy Description
An internist who specializes in the diagnosis and treatment of all types of cancer and other benign and malignant tumors. This specialist decides on and administers therapy for these malignancies as well as consults with surgeons and radiotherapists on other treatments for cancer.

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No. Taxonomy Code Type Classification /
Specialization
License No. (State)
1207RH0000XAllopathic & Osteopathic Physicians

Internal Medicine
Hematology

30373 (SC)
2207RH0000XAllopathic & Osteopathic Physicians

Internal Medicine
Hematology

ME83970 (FL)
3207RH0003XAllopathic & Osteopathic Physicians

Internal Medicine
Hematology & Oncology

435665 (PA)

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

  • Aetna CVS Health

    • Bronze 4: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - HMO
    • Bronze S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - HMO
    • Gold 3: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - HMO
    • Gold 4: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - HMO
    • Gold S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - HMO
    • Silver 5: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - HMO
    • Silver 6: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - HMO
    • Silver 7: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - HMO
    • Silver S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - HMO
  • AvMed

    • AvMed Entrust Bronze 600 (2024) - HMO
    • AvMed Entrust Bronze 625 Dental+Vision (2024) - HMO
    • AvMed Entrust Bronze 650 (2024) - HMO
    • AvMed Entrust Expanded Bronze Standard (2024) - HMO
    • AvMed Entrust Gold 125 (2024) - HMO
    • AvMed Entrust Gold 125 Dental+Vision (2024) - HMO
    • AvMed Entrust Gold Standard (2024) - HMO
    • AvMed Entrust Platinum 25 (2024) - HMO
    • AvMed Entrust Platinum 25 Dental+Vision (2024) - HMO
    • AvMed Entrust Platinum Standard (2024) - HMO
  • Florida Blue (BlueCross BlueShield FL)

    • BlueOptions Bronze (HSA) 24J01-10 (Rewards $$$ / $4 Condition Care Rx) - PPO
    • BlueOptions Bronze 24J01-04 ($0 Virtual Visits / 3 PCP Visits for $0 then $40 / Rewards $$$) - PPO
    • BlueOptions Bronze 24J01-06 ($0 Virtual Visits / Rewards $$$) - PPO
    • BlueOptions Bronze 24J01-17 ($0 Virtual Visits / $50 PCP Visits / Rewards $$$) - PPO
    • BlueOptions Bronze 24J01-18S (Multilingual Available / Rewards $$$) - PPO
    • BlueOptions Gold 24J01-09 ($0 Virtual Visits / $20 PCP Visits / $15 Generic Meds / Rewards $$$) - PPO
    • BlueOptions Gold 24J01-12 ($0 Virtual Visits / $20 Labs / Rewards $$$) - PPO
    • BlueOptions Gold 24J01-20S ($30 PCP Visits / Multilingual Available / Rewards $$$) - PPO
    • BlueOptions Platinum 24J01-05 ($0 Virtual Visits / Rewards $$$) - PPO
    • BlueOptions Platinum 24J01-08 ($0 Virtual Visits / Rewards $$$) - PPO
  • Florida Blue HMO (a BlueCross BlueShield FL company)

    • BlueCare Bronze (HSA) 24K01-09 (Rewards $$$ / $4 Condition Care Rx) - POS
    • BlueCare Bronze 24K01-03 ($0 Virtual Visits / 3 PCP Visits for $0 then $40 / Rewards $$$) - POS
    • BlueCare Bronze 24K01-05 ($0 Virtual Visits / Rewards $$$) - POS
    • BlueCare Bronze 24K01-25 ($0 Virtual Visits / $50 PCP Visit / $30 Generic Meds / Rewards $$$) - POS
    • BlueCare Bronze 24K01-31S (Multilingual Available / Rewards $$$) - POS
    • BlueCare Bronze 24K02-17 ($0 Virtual Visits / 3 PCP Visits for $0 then $40 / Rewards $$$) - POS
    • BlueCare Bronze 24K02-18 ($0 Virtual Visits / Rewards $$$) - POS
    • BlueCare Bronze 24K02-23 ($0 Virtual Visits / $50 PCP Visit / $30 Generic Meds / Rewards $$$) - POS
    • BlueCare Bronze 24K02-26S (Multilingual Available / Rewards $$$) - POS
    • BlueCare Gold 24K01-08 ($0 Virtual Visits / $20 PCP Visit / $15 Generic Meds / Rewards $$$) - POS
  • Medicare

  • Medicaid

  • Blue Cross Blue Shield


*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State Identifier Issuer
1022465770001MEDICAID (05)PA 
259450100MEDICAID (05)FL 
35803OTHER (01)FLBLUE CROSS BLUE SHIELD

PECOS Enrollment and Medicare Participation Status

George Simon is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

  • Is the provider registered in PECOS? Yes

  • PECOS PAC ID: 4880784560

    What is the PECOS Associate Control ID?
    A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.

  • PECOS Enrollment ID: I20071218000532

    What is the Provider Enrollment ID?
    The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.

  • Accepts Medicare Assignment? Yes

    What does it mean "accepts medicare assignment"?
    When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
    A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.

  • Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes

  • Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes

  • Eligible to Order or Refer a Home Health Agency (HHA): Yes

  • Eligible to Order or Refer Power Mobility Devices: Yes

Physician Visit Costs

The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.

For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.

The prices below reflect the costs for new and established patients in the 34747 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99205

  • Average New Patient Price $178.79
  • Minimum New Patient Price $58.4
  • Maximum New Patient Price $178.79
  • Average New Patient Copayment $44.69
  • Minimum New Patient Copayment $14.6
  • Maximum New Patient Copayment $44.69

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99214

  • Average Established Patient Price $103.76
  • Minimum Established Patient Price $17.74
  • Maximum Established Patient Price $145.28
  • Average Established Patient Copayment $25.94
  • Minimum Established Patient Copayment $4.43
  • Maximum Established Patient Copayment $36.32

* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.

Overall MIPS Quality Performance

The Merit-based Incentive Payment System (MIPS) is a way providers could use to participate in CMS Quality Payment Program (QPP). The MIPS program affects clinician reimbursement for Part B covered professional services and also rewards them for improving the quality of patient care and outcomes.

  • Final Score: 94.68 out of 100

    The MIPS program evaluates providers across multiple categories with a specific weight for each category resulting a in a MIPS final score that ranges from 0 to 100 points. The MIPS Final Score determines whether providers receive a negative, neutral or positive MIPS payment adjustment.

  • Quality Score: 91.42

    The Quality category assesses providers performance on clinical practices and patient outcomes under the traditional MIPS program. The quality measures help identify the quality of healthcare processes, outcomes, and patient experiences. The Quality measure category compromises 40% providers final MPIS scores.

    There are six collection types for MIPS quality measures: Electronic Clinical Quality Measures (eCQMs), MIPS Clinical Quality Measures (CQMs), Qualified Clinical Data Registry (QCDR) Measures, Medicare Part B claims measures, CMS Web Interface measures and The Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS Survey.

  • Promoting Interoperability Score: 98

    The Interoperability category measures the providers ability to use technology to exchange and make use of healthcare information in a way that is less burdensome and improves outcomes. The Interoperability measure category compromises 25% providers final MPIS scores.

    The MIPS Interoperability measure focuses on the use of certified electronic health record technology (CEHRT) to improve patient access health information, the exchange of information between clinicians and pharmacies and the systematic collection, analysis, and interpretation of healthcare data.

  • Improvement Activities Score: 40

    The Improvement Activities performance category evaluates the providers participation in clinical activities that support the improvement of clinical practice, care delivery, and outcomes. Providers have the option to choose 2 to 4 activities from an inventory of over 100 improvement activities. Providers typically choose the activities that best fit their needs. The improvement activities measure category compromises 15% providers final MPIS scores.

    The Improvement measures aim to better patient engagement, patient safety and other areas of patient care. The Improvement Activities category compromises 15% of providers final MPIS scores.

  • Cost Score: N/A

    The Cost performance category asses the amount and types of services provided and how clinicians coordinate care and seek improvement of health outcomes by ensuring patients receive the appropriate services.

    Although providers don't determine the price of healthcare services they are important in delivering high-quality care at a reasonable cost. The Cost measures category compromises 20% of providers final MPIS scores.

  • Cost Score: N/A

    The Cost performance category asses the amount and types of services provided and how clinicians coordinate care and seek improvement of health outcomes by ensuring patients receive the appropriate services.

    Although providers don't determine the price of healthcare services they are important in delivering high-quality care at a reasonable cost. The Cost measures category compromises 20% of providers final MPIS scores.

Reviews for DR. GEORGE RAJAN SIMON MD

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1164438768
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
211248316712
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 1 + 1 + 2 + 4 + 8 + 3 + 1 + 6 + 7 + 1 + 2 + 24 = 62
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 62 = 88

The NPI number 1164438768 is valid because the calculated check digit 8 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 14 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1558621888 KRISTELL VALVERDE M.D.
Individual
Obstetrics & Gynecology380 CELEBRATION PL FL 2
CELEBRATION, FL 34747
(321) 939-3553
1073731444 DONOVAN ROSAS
Individual
Plastic Surgery380 CELEBRATION PL FL 2
CELEBRATION, FL 34747
(407) 303-4760
1255784872MS. LAUREN MCKIERNAN PA-C
Individual
Physician Assistant380 CELEBRATION PL FL 2
CELEBRATION, FL 34747
(407) 303-4760
1174910681DR. SUBHIA REHMAN M.D
Individual
Obstetrics & Gynecology (Obstetrics)380 CELEBRATION PL FL 2
CELEBRATION, FL 34747
(407) 303-4220
1285078436DR. JEREMY RICHARD JOHN MD, MPH
Individual
Surgery380 CELEBRATION PL FL 2
CELEBRATION, FL 34747
(407) 303-4760
1346560778DR. XAVIER ROMAN-HERNANDEZ MD
Individual
Obstetrics & Gynecology380 CELEBRATION PL FL 2
CELEBRATION, FL 34747
(407) 303-4220
1750680310DR. ERICA L STOCKWELL D.O.
Individual
Obstetrics & Gynecology380 CELEBRATION PL FL 2
CELEBRATION, FL 34747
(407) 303-4190
1013356872 DEBORAH LEE BRADY-HULL APRN
Individual
Nurse Practitioner (Family)380 CELEBRATION PL FL 2
CELEBRATION, FL 34747
(407) 821-3627
1942704044MRS. NICOLE MARIE JIMENEZ APRN
Individual
Nurse Practitioner (Women's Health)380 CELEBRATION PL FL 2
CELEBRATION, FL 34747
(407) 303-4220
1053631333 MARY R LANGENSTROER MD
Individual
Obstetrics & Gynecology380 CELEBRATION PL FL 2
CELEBRATION, FL 34747
(321) 939-3553
1194177311DR. JEAN CARLOS VEL M.D.
Individual
Obstetrics & Gynecology380 CELEBRATION PL FL 2
CELEBRATION, FL 34747
(407) 303-4220
1346523867DR. ANGEL RAFAEL GONZALEZ RIOS M.D.
Individual
Obstetrics & Gynecology380 CELEBRATION PL FL 2
CELEBRATION, FL 34747
(407) 303-4190
1912662982 BAILEY ELIZABETH FLORIN PA-C
Individual
Physician Assistant380 CELEBRATION PL FL 2
CELEBRATION, FL 34747
(407) 303-4190
1952173148 ELIANA GUERRERO PA-C
Individual
Physician Assistant380 CELEBRATION PL FL 2
KISSIMMEE, FL 34747
(407) 303-4190

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1164438768, enumerated in the NPI registry as an "individual" on August 01, 2006

The provider is located at 380 Celebration Pl Fl 2 Celebration, Fl 34747 and the phone number is (843) 792-1414

The provider's speciality is Internal Medicine with taxonomy code 207RX0202X with a focus in Medical Oncology

The provider has more than 39 years of experience.

The provider might be accepting Accepts: Aetna CVS Health, AvMed, Florida Blue (BlueCross. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

Yes, as of July 16, 2024 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

The provider has an overall high rating in the following quality measures: quality clinical practices and patient outcomes and experiences , uses technology to exchange and make use of healthcare information.

Medicare beneficiaries should expect a typical cost of $178.79 with an average copayment of $44.69 for new patient appointments. Established patients should expect a typical charge of $103.76 and an average copayment of 25.94. Please review your insurance plan or contact the provider directly to determine your specific costs.

This NPI record was last updated on August 01, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.