DR. CHARLES W. SIMMONS JR. M.D.
NPI 1801869839
Emergency Medicine in San Diego, CA

NPI Status: Active since February 09, 2006

Contact Information

4077 5TH AVE
EMERGENCY MEDICINE
SAN DIEGO, CA
ZIP 92103
Phone: (619) 260-7095

NPI Profile Information
Primary Taxonomy
Insurance Plans Accepted
Medicare Participation & PECOS Status
Physician Visit Costs
Quality Reporting
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Male
Emergency Medicine
PECOS Enrolled
Medicare Quality Reporting

About CHARLES SIMMONS

This page provides the complete NPI Profile along with additional information for Charles Simmons, a provider established in San Diego, California with a medical specialization in Emergency Medicine. The healthcare provider is registered in the NPI registry with number 1801869839 assigned on February 2006. The practitioner's primary taxonomy code is 207P00000X with license number G71866 (CA). The provider is registered as an individual and his NPI record was last updated 17 years ago.

NPI: 1801869839
Provider Name: DR. CHARLES W. SIMMONS JR. M.D.
Gender: Male
Entity Type: Individual
Location Address: 4077 5TH AVE EMERGENCY MEDICINE SAN DIEGO, CA 92103
Location Phone: (619) 260-7095
Mailing Address: 4077 5TH AVE EMERGENCY MEDICINE SAN DIEGO, CA 92103
Mailing Phone: (619) 260-7095
Is Sole Proprietor?: No
Enumeration Date: 02-09-2006
Last Update Date: 03-03-2008
Code Navigator

Location Map

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: Emergency Medicine
Taxonomy Code: 207P00000X
Type: Allopathic & Osteopathic Physicians
License No.: G71866
License State: CA
Taxonomy Description: An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.

Insurance Plans Accepted

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

Medicare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicaid

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*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
WG71866H	MEDICARE PIN (08)	CA
F19739	MEDICARE UPIN (02)	CA
00G718660	MEDICAID (05)	CA
WG718661	MEDICARE PIN (08)	CA

Medicare Participation & PECOS Enrollment Status

Charles Simmons 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
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 92103 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99203

Average New Patient Price $94.87
Minimum New Patient Price $62.1
Maximum New Patient Price $184.71

Average New Patient Copayment $23.71
Minimum New Patient Copayment $15.52
Maximum New Patient Copayment $46.17

Established Patients Visit Costs *

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

Average Established Patient Price $108.42
Minimum Established Patient Price $20.62
Maximum Established Patient Price $151.42

Average Established Patient Copayment $27.1
Minimum Established Patient Copayment $5.15
Maximum Established Patient Copayment $37.85

* 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.

Quality Reporting

The provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.

Quality Measure	Performance	Number of Patients
Annual registration in the Prescription Drug Monitoring Program	Yes	N/A
Annual registration by eligible clinician or group in the prescription drug monitoring program of the state where they practice. Activities that simply involve registration are not sufficient. MIPS eligible clinicians and groups must participate for a minimum of 6 months.
Consultation of the Prescription Drug Monitoring Program	Yes	N/A
Clinicians would attest to reviewing the patients’ history of controlled substance prescription using state prescription drug monitoring program (PDMP) data prior to the issuance of a Controlled Substance Schedule II (CSII) opioid prescription lasting longer than 3 days. For the transition year, clinicians would attest to 60 percent review of applicable patient’s history. For the Quality Payment Program Year 2 and future years, clinicians would attest to 75 percent review of applicable patient’s history performance.
Tobacco use	Yes	N/A
Tobacco use: Regular engagement of MIPS eligible clinicians or groups in integrated prevention and treatment interventions, including tobacco use screening and cessation interventions (refer to NQF #0028) for patients with co-occurring conditions of behavioral or mental health and at risk factors for tobacco dependence.

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.
1	8	0	1	8	6	9	8	3	9
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2	8	0	1	16	6	18	8	6
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 8 + 0 + 1 + 1 + 6 + 6 + 1 + 8 + 8 + 6 + 24 = 71
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
80 - 71 = 9									9

The NPI number 1801869839 is valid because the calculated check digit 9 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location

The following 20 providers are registered at the same or nearby location.

DR. JULIAN GEORGE LIS M.D.

Emergency Medicine

4077 5TH AVE
SAN DIEGO, CA
ZIP 92103

About CHARLES SIMMONS

Location Map

Specialty - Primary Taxonomy

Emergency Medicine

Insurance Plans Accepted

Medicare

Medicaid

Additional Identifiers

Medicare Participation & PECOS Enrollment Status

Is the provider registered in PECOS? Yes

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

New Patients Visit Costs *

Established Patients Visit Costs *

Quality Reporting

Reviews for DR. CHARLES W. SIMMONS JR. M.D.

NPI Validation Check Digit Calculation

Other Providers at the Same Location

Frequently Asked Questions

What is Charles Simmons's NPI number?

Where is the provider located?

What is the provider's specialty?

What insurance does Charles Simmons accept?