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DR. JACK SIMON M.D.
NPI 1861694135
Psychiatry & Neurology - Psychiatry in Los Altos, CA

Active since May 31, 2007Opted out of Medicare · through Oct 3, 2027
164 MAIN ST, LOS ALTOS, CA 94022(650) 941-6670(650) 949-1262 Get Directions Write a Review

NPPES record last updated: July 9, 2007. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Jack Simon M.d. NPPES

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

DR. JACK SIMON M.D. (NPI 1861694135) is an individual psychiatry provider in Los Altos, California, licensed in California (G19513) and active in the NPI registry since May 2007. He has opted out of Medicare through October 3, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1861694135
Entity TypeIndividualMale
Primary Taxonomy2084P0800X
Provider Legal NameDR. JACK SIMONCredential: M.D.
Location Address164 MAIN STLos Altos, CA 94022-2928
Mailing Address164 Main St.Los Altos, CA 94022 · (650) 941-6670 · Fax (650) 949-1262
Phone(650) 941-6670
Fax(650) 949-1262
Sole ProprietorYes
Enumeration DateMay 31, 2007
Last NPPES UpdateJuly 9, 2007
✔ NPI 1861694135 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatry & Neurology · PsychiatryAllopathic & Osteopathic Physicians
Taxonomy Code2084P0800X
License✔ Licensed in CA · G19513
Definition
A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems.
164 MAIN ST, Los Altos, CA 94022
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Other Identifiers 1

Medicare UPIN00G195130CA

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Jack Simon M.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from October 3, 2015 through October 3, 2027.

Opt-Out Effective DateOctober 3, 2015
Opt-Out In Effect ThroughOctober 3, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 94022 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
$206.04 typical visit price
range $70.37 – $206.04
Typical copayment $51.51 (range $17.59 – $51.51)
Most-billed visit code 99205
Established Patient
$86.56 typical visit price
range $23.96 – $169.60
Typical copayment $21.64 (range $5.99 – $42.40)
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.

Other Providers at the Same Location NPPES

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

L ALLEN SCIUTTO LMFT
Marriage & Family Therapist
164 MAIN ST, SUITE 200
LOS ALTOS, CA 94022
Santa Clara County (650) 223-5607

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 Jack Simon's NPI number?

The NPI number for Jack Simon is 1861694135. It was assigned to this individual provider in the NPPES registry on May 31, 2007.

Where is Jack Simon located?

Jack Simon practices at 164 Main St, Los Altos, CA 94022. The listed phone number is (650) 941-6670.

What is Jack Simon's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Psychiatry, with taxonomy code 2084P0800X.

Is Jack Simon enrolled in Medicare?

No. Jack Simon has opted out of Medicare through October 3, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Jack Simon was last updated on July 9, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.