MICHAEL GRAYSON SIMMONS MD
NPI 1225023344
Urology in Gainesville, GA

Q: What is Michael Simmons's NPI number?

The NPI number for Michael Simmons is 1225023344. It was assigned to this individual provider in the NPPES registry on September 14, 2005.

Q: What is Michael Simmons's specialty?

The primary specialty registered for this NPI is Urology with taxonomy code 208800000X.

Q: When was this NPI record last updated?

The NPPES record for Michael Simmons was last updated on January 13, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since September 14, 2005PECOS EnrolledAccepts Medicare Assignment

92.24/100

CMS Quality Rating

743 SPRING ST NE, GAINESVILLE, GA 30501(770) 219-8430 Get Directions Write a Review

NPPES record last updated: January 13, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Michael Grayson Simmons Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MICHAEL GRAYSON SIMMONS MD (NPI 1225023344) is an individual urology provider in Gainesville, Georgia, licensed in Georgia (93682) and active in the NPI registry since September 2005. He is enrolled in Medicare PECOS, is affiliated with Northeast Georgia Medical Center, Inc, and maintains a secondary practice location in Scottsboro.

NPPES Registry Identity

NPI1225023344

Entity TypeIndividualMale

Primary Taxonomy208800000X

Provider Legal NameMICHAEL GRAYSON SIMMONSCredential: MD

Location Address743 SPRING ST NEGainesville, GA 30501-3715

Mailing Address750 Byron RdScottsboro, AL 35769-4051 · (256) 259-8765 · Fax (256) 716-8060

Phone(770) 219-8430

Sole ProprietorNo

Medical School CMSUniversity Of Alabama School Of MedicineGraduated 1992

Enumeration DateSeptember 14, 2005

Last NPPES UpdateJanuary 13, 2025

NPPES CertifiedJanuary 13, 2025

✔ NPI 1225023344 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyUrologyAllopathic & Osteopathic Physicians

Taxonomy Code208800000X

Licenses✔ Licensed in GA · 93682✔ Licensed in AL · 17993

Definition

A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.

743 SPRING ST NE, Gainesville, GA 30501

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Secondary Practice Location 1

Location 1750 Byron RdScottsboro, AL 35769-4051 · Phone (256) 259-8765 · Fax (256) 716-8060

Other Identifiers 4

Medicaid256068200FL

Medicaid00820619CGA

Medicaid106277AL

Medicaid106278AL

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Buckeye Health Plan, Ambetter from Home State Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Michael Grayson Simmons Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5294799714

PECOS Enrollment IDI20081119000660, I20240619001542, I20240708002147

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 21

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

428 services257 patients

Automated urinalysis test 81003

An automated urinalysis test is a routine examination that checks your urine for various substances. It can help identify potential health issues such as kidney problems or diabetes. The test uses a machine to analyze a small urine sample, providing quick and accurate results.

325 services217 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

209 services161 patients

Manual urinalysis test with examination using microscope, automated 81001

A manual urinalysis test with automated microscopic examination is a lab process that checks your urine for health indicators. It involves a machine scanning your sample to identify any abnormal elements, which can assist in diagnosing various conditions.

162 services105 patients

Insertion of needle into vein for collection of blood sample 36415

This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.

152 services98 patients

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

99 services99 patients

Assessment of emotional or behavioral problems 96127

Assessment of emotional or behavioral problems involves a thorough evaluation of your feelings, thoughts, and behaviors. It's a process where professionals study patterns over time to identify potential issues like anxiety, depression, or other mental health conditions.

83 services71 patients

Ultrasound measurement of bladder capacity after voiding 51798

Ultrasound measurement of bladder capacity after voiding is a non-invasive test that uses sound waves to create images of your bladder. It's done after you've emptied your bladder to see if there's any leftover urine, which can help diagnose certain conditions.

71 services62 patients

Diagnostic exam of bladder and urethra using an endoscope 52000

This procedure involves using a thin, flexible tube with a light, called an endoscope, to examine the bladder and urethra. It helps in identifying any abnormalities or issues that may be causing discomfort or other symptoms.

66 services58 patients

Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222

Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.

65 services63 patients

Leuprolide acetate (for depot suspension), 7.5 mg J9217

Leuprolide acetate is a medication that helps regulate certain hormone levels in your body. It's injected into your muscle once a month. This treatment can help manage various health conditions related to hormone imbalance. Always follow your doctor's instructions.

64 services14 patients

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

39 services39 patients

Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle 96402

This procedure involves the injection of hormone-based anti-cancer drugs under the skin or into a muscle. These medications help to slow down or stop the growth of certain types of cancer cells. The process is usually quick and can be performed in a clinic or hospital.

32 services14 patients

Initial hospital care with straightforward or low level of medical decision making, per day, if using time, at least 40 minutes 99221

Initial hospital inpatient care refers to the first day of your stay in the hospital. This service typically includes a 30-minute check-up with a healthcare professional. They'll assess your health, discuss your condition, and plan your treatment. It's part of ensuring you receive the best possible care.

29 services29 patients

Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes 99231

Follow-up hospital inpatient care is a daily service where a healthcare professional checks on your health progress during your hospital stay. Each session typically lasts 15 minutes, involving updates on your condition and adjustments to your treatment plan, if necessary.

22 services17 patients

Ultrasound scan of pelvic region through rectum 76872

An ultrasound scan of the pelvic region through the rectum is a medical procedure where a small, smooth device is gently inserted into the rectum. This device uses sound waves to create images of the internal structures in the lower abdomen, aiding in diagnosis and treatment planning.

18 services16 patients

Manual urinalysis test with examination using microscope, non-automated 81000

A manual urinalysis test involves studying a urine sample under a microscope. This non-automated method helps identify any abnormal substances present. It's a useful tool for detecting potential health concerns early. The process is simple and non-invasive.

16 services11 patients

Biopsy of prostate gland 55700

A biopsy of the prostate gland is a procedure where a small sample of tissue is taken from your body's internal gland, located near the bladder, for testing. This helps in diagnosing potential health issues. It's usually done with a fine needle and imaging technology for accuracy.

15 services13 patients

Insertion of stent in ureter using an endoscope 52332

This procedure involves placing a small, flexible tube (stent) in your body's drainage system to help urine flow from the kidneys to the bladder. An endoscope, a thin tube with a light and camera, is used for precise placement.

14 services12 patients

Imaging of urinary tract following injection of a contrast agent 74420

This procedure involves injecting a contrast agent into your body to help highlight the urinary tract during imaging. The contrast agent makes your urinary tract more visible on the images, providing detailed information about its structure and function. This can help in diagnosing any potential issues.

12 services11 patients

Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215

This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.

11 services11 patients

Hospital Affiliations CMS Care Compare 4

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Northeast Georgia Medical Center, Inc

Acute Care Hospitals · Gainesville, GA

3/5 CMS rating

OwnershipGovernment - Local

CMS Certification Number110029

Location743 Spring StreetGainesville, GA 30501 · Hall County

Emergency services Birthing friendly

Atrium Health Floyd Medical Center

Acute Care Hospitals · Rome, GA

2/5 CMS rating

OwnershipGovernment - Hospital District or Authority

CMS Certification Number110054

Location304 Turner Mccall BoulevardRome, GA 30162 · Floyd County

Birthing friendly

Piedmont Newnan Hospital, Inc

Acute Care Hospitals · Newnan, GA

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number110229

Location745 Poplar RoadNewnan, GA 30265 · Coweta County

Emergency services Birthing friendly

Mercy Health - Lourdes Hospital

Acute Care Hospitals · Paducah, KY

2/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number180102

Location1530 Lone Oak RoadPaducah, KY 42003 · Mc Cracken County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 30501 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$124.10 typical visit price

range $53.31 – $164.04

Typical copayment $31.02 (range $13.32 – $41.01)

Most-billed visit code 99204

Established Patient

$66.89 typical visit price

range $16.68 – $133.24

Typical copayment $16.72 (range $4.17 – $33.31)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

92.24/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

Quality

96.27

Promoting Interoperability

Improvement Activities

Cost

68.83

Reported Quality Measures

Advance Care Plan

100%634 patients5/55-star benchmark: 100%

Benign Prostate Hyperplasia (BPH): Inappropriate Lab & Imaging Services for Patients with BPH

Lower rates are better for this measure.

0%114 patients5/55-star benchmark: 100%

Documentation of Current Medications in the Medical Record

99%1,572 patients4/55-star benchmark: 100%

Hospital admissions or infectious complications within 30 days of prostate biopsy

Lower rates are better for this measure.

3%338 patients

Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan

99%1,414 patients4/55-star benchmark: 100%

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Patients combinedPopulations: 97% · 589 patients

Patients screened: 100% · 589 patients

76%112 patients4/55-star benchmark: 100%

Stones: Urinalysis Performed Before Surgical Stone Procedures

98%130 patients4/55-star benchmark: 100%

Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence in Women Aged 65 Years and Older

94%151 patients4/55-star benchmark: 100%

Urinary Incontinence: Plan of Care for Urinary Incontinence in Women Aged 65 Years and Older

93%85 patients4/55-star benchmark: 100%

Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Referred Medical Equipment & Supplies CMS DME claims 4

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Lubricant, individual sterile packet, each A4332

DME-Medical/Surgical Supplies · category DA000N

2 suppliers35 claims4,690 services$0.10 avg. paid by Medicare

Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each A4351

DME-Orthotic Devices · category DF008N

4 suppliers97 claims15,140 services$1.72 avg. paid by Medicare

Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, silicone elastomeric, or hydrophilic, etc.), each A4352

DME-Orthotic Devices · category DF008N

2 suppliers66 claims7,932 services$5.97 avg. paid by Medicare

Lubricant, per ounce A4402

DME-Orthotic Devices · category DF010N

1 supplier12 claims204 services$1.54 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DARRYL E BLALOCK CRNA

Nurse Anesthetist, Certified Registered