JACKIE GRANT SIMONDS DO
NPI 1255190682
Student in an Organized Health Care Education/Training Program in Largo, FL

Q: What is Jackie Simonds's NPI number?

The NPI number for Jackie Simonds is 1255190682. It was assigned to this individual provider in the NPPES registry on March 18, 2024.

Q: What is Jackie Simonds's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Jackie Simonds was last updated on March 18, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years 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 March 18, 2024PECOS Enrolled

201 14TH ST SW, LARGO, FL 33770(727) 588-5200 Get Directions Write a Review

NPPES record last updated: March 18, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

On this page

About Jackie Grant Simonds Do NPPES

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

JACKIE GRANT SIMONDS DO (NPI 1255190682) is an individual student in an organized health care education/training program in Largo, Florida and active in the NPI registry since March 2024. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1255190682

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameJACKIE GRANT SIMONDSCredential: DO

Location Address201 14TH ST SWLargo, FL 33770-3133

Mailing Address4621 Windcroft CirHoschton, GA 30548-3484 · (770) 875-5187 · Fax (309) 326-4515

Phone(727) 588-5200

Sole ProprietorYes

Enumeration DateMarch 18, 2024

NPPES CertifiedMarch 18, 2024

✔ NPI 1255190682 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

201 14TH ST SW, Largo, FL 33770

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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jackie Grant Simonds Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

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.

DR. RAOUL RUDOLPH BOTHA MD

Internal Medicine