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SIMON KIDANEMARIAM MD
NPI 1811790652
Student in an Organized Health Care Education/Training Program in Brockton, MA

Active since March 28, 2025PECOS Enrolled
680 CENTRE ST, BROCKTON, MA 02302(508) 941-7210 Get Directions Write a Review

NPPES record last updated: March 28, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Simon Kidanemariam Md NPPES

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

SIMON KIDANEMARIAM MD (NPI 1811790652) is an individual student in an organized health care education/training program in Brockton, Massachusetts and active in the NPI registry since March 2025. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1811790652
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameSIMON KIDANEMARIAMCredential: MD
Location Address680 CENTRE STBrockton, MA 02302-3308
Mailing Address99 Irving AveProvidence, RI 02906-4507 · (301) 793-1165
Phone(508) 941-7210
Sole ProprietorYes
Enumeration DateMarch 28, 2025
NPPES CertifiedMarch 28, 2025
✔ NPI 1811790652 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.
680 CENTRE ST, Brockton, MA 02302
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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)

Simon Kidanemariam Md 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.

LOUIS D. GOTTLIEB M.D.
Internal Medicine
680 CENTRE ST, MANAGED CARE
BROCKTON, MA 02302
Plymouth County (508) 941-7065
MS. JAMIE CHYAT PA-C
Physician Assistant
680 CENTRE ST
BROCKTON, MA 02302
Plymouth County (508) 941-7000
BRANDEN M TURNER LMHC
Counselor (Mental Health)
680 CENTRE ST
BROCKTON, MA 02302
Plymouth County (508) 941-7228
CARLY ALEXANDRA CARLIN MD
Psychiatry & Neurology (Psychiatry)
680 CENTRE ST
BROCKTON, MA 02302
Plymouth County (508) 941-7228
DR. ANGEL TAYLOR MD
Student in an Organized Health Care Education/Training Program
680 CENTRE ST
BROCKTON, MA 02302
Plymouth County (508) 974-7000
DR. DESIREE A CARLSON MD
Pathology (Anatomic Pathology & Clinical Pathology)
680 CENTRE ST, PATHOLOGY DEPARTMENT
BROCKTON, MA 02302
Plymouth County (508) 941-7414
DEMIN MA M.D.
Psychiatry & Neurology (Psychiatry)
680 CENTRE ST
BROCKTON, MA 02302
Plymouth County (508) 941-7228
JENNIFER L. BUNKER
Social Worker
680 CENTRE ST
BROCKTON, MA 02302
Plymouth County (508) 941-7268

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Simon Kidanemariam's NPI number?

The NPI number for Simon Kidanemariam is 1811790652. It was assigned to this individual provider in the NPPES registry on March 28, 2025.

Where is Simon Kidanemariam located?

Simon Kidanemariam practices at 680 Centre St, Brockton, MA 02302. The listed phone number is (508) 941-7210.

What is Simon Kidanemariam's specialty?

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

Is Simon Kidanemariam enrolled in Medicare?

Yes. Simon Kidanemariam is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Simon Kidanemariam was last updated on March 28, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.