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SIDNEY KAY SIMONIAN D.O.
NPI 1902849045
Ophthalmology in Madison Heights, MI

Active since June 14, 2006PECOS EnrolledAccepts Medicare Assignment
1421 E. 12 MILE, BLDG. A, MADISON HEIGHTS, MI 48071(248) 547-6656(248) 547-5407 Get Directions Write a Review

NPPES record last updated: June 3, 2011. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Sidney Kay Simonian D.o. NPPES

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

SIDNEY KAY SIMONIAN D.O. (NPI 1902849045) is an individual ophthalmology provider in Madison Heights, Michigan, licensed in Michigan (SS0007420) and active in the NPI registry since June 2006. She is enrolled in Medicare PECOS, is affiliated with Straith Hospital For Special Surgery, and is a graduate of Albany Medical College Of Union University (1974).

NPPES Registry Identity

NPI1902849045
Entity TypeIndividualFemale
Primary Taxonomy207W00000X
Provider Legal NameSIDNEY KAY SIMONIANCredential: D.O.
Location Address1421 E. 12 MILE, BLDG. AMadison Heights, MI 48071-2653
Mailing Address1421 E 12 Mile Rd Bldg AMadison Heights, MI 48071-2653 · (248) 547-6656 · Fax (248) 547-5407
Phone(248) 547-6656
Fax(248) 547-5407
Sole ProprietorNo
Medical School CMSAlbany Medical College Of Union UniversityGraduated 1974
Enumeration DateJune 14, 2006
Last NPPES UpdateJune 3, 2011
✔ NPI 1902849045 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOphthalmologyAllopathic & Osteopathic Physicians
Taxonomy Code207W00000X
License✔ Licensed in MI · SS0007420
Definition
An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses.
1421 E. 12 MILE, Madison Heights, MI 48071
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Other Identifiers 10

Other382318591MI · Vision Service Plan / Vsp
Medicare UPINB44425MI
Other180008618MI · Mrrr
Medicaid139455411MI
Other8631110001MI · Mrpb
Other1856303004MI · Bcn
Other5630300MI · Blue Cross Blue Shield
Medicare PINMI3068001MI
Medicare NSC0441340002MI
Other382318591MI · Commercial

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter 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

Sidney Kay Simonian D.o. 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 ID1153446281
PECOS Enrollment IDI20100914000302
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 12

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 complete exam of visual system 92014
An established patient complete exam of the visual system involves a thorough check of your eyes and vision. It assesses eye health, checks for diseases, and measures your ability to see clearly at different distances. It's a routine, non-invasive procedure.
340 services314 patients
Established patient problem focused exam of visual system 92012
This is a routine check-up for existing patients focusing on the visual system. It involves examining your eyes to detect any potential issues or changes in your vision. It's a crucial part of maintaining good eye health.
281 services148 patients
Photography of the retina 92250
Photography of the retina, also known as retinal imaging, is a non-invasive procedure that captures images of the back of your eye. This helps doctors identify and monitor conditions like glaucoma, macular degeneration, or diabetic retinopathy. It's painless and quick, often part of a routine eye exam.
216 services212 patients
Exam of visual field with extended testing 92083
An extended visual field exam is a detailed test to evaluate your peripheral (side) vision. It helps to detect any potential blind spots which may not be noticeable in daily life. These could be caused by eye diseases like glaucoma, or neurological conditions.
84 services83 patients
Imaging of optic nerve 92133
Imaging of the optic nerve is a non-invasive procedure that captures detailed pictures of your optic nerve. It helps doctors assess eye health, particularly for conditions like glaucoma. It's painless, quick, and uses safe technology like MRI or OCT (Optical Coherence Tomography).
80 services79 patients
Ultrasound scan of cornea to determine thickness 76514
An ultrasound scan of the cornea is a non-invasive procedure that uses sound waves to measure the thickness of your cornea. This helps in diagnosing certain eye conditions and planning treatments. No discomfort or pain is typically experienced.
77 services76 patients

Hospital Affiliations CMS Care Compare 2

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

Straith Hospital For Special Surgery

Acute Care Hospitals · Southfield, MI
OwnershipVoluntary non-profit - Private
CMS Certification Number230071
Location23901 LahserSouthfield, MI 48033 · Oakland County

Ascension Macomb Oakland Hosp-Warren Campus

Acute Care Hospitals · Warren, MI
2/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number230195
Location11800 East Twelve Mile RoadWarren, MI 48093 · Macomb County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 48071 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
$134.28 typical visit price
range $58.04 – $177.36
Typical copayment $33.57 (range $14.51 – $44.34)
Most-billed visit code 99204
Established Patient
$72.38 typical visit price
range $18.32 – $143.49
Typical copayment $18.09 (range $4.58 – $35.87)
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.

Reported Quality Measures

Age-Related Macular Degeneration (AMD): Counseling on Antioxidant Supplement
Percentage of patients aged 50 years and older with a diagnosis of age-related macular degeneration (AMD) or their caregiver(s) who were counseled within 12 months on the benefits and/or risks of the Age-Related Eye Disease Study (AREDS) formulation for…
71%112 patients3/55-star benchmark: 100%
Age-Related Macular Degeneration (AMD): Dilated Macular Examination
Percentage of patients aged 50 years and older with a diagnosis of age-related macular degeneration (AMD) who had a dilated macular examination performed which included documentation of the presence or absence of macular thickening or geographic atrophy or…
71%112 patients2/55-star benchmark: 100%
Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery
Percentage of patients aged 18 years and older with a diagnosis of uncomplicated cataract who had cataract surgery and no significant ocular conditions impacting the visual outcome of surgery and had best-corrected visual acuity of 20/40 or better (distance…
99%77 patients
Diabetes: Eye Exam
Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period
100%357 patients5/55-star benchmark: 100%
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care
Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus…
77%52 patients4/55-star benchmark: 100%
Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed which included documentation of the level of severity of retinopathy and the presence or absence of macular edema during…
65%72 patients3/55-star benchmark: 100%
Documentation of Current Medications in the Medical Record
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter.
100%2,713 patients5/55-star benchmark: 100%
e-Prescribing
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
100%231 patients5/55-star benchmark: 100%
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user
Patients screenedForUse: 100% · 457 patients
Patients tobacco: 86% · 457 patients
8%65 patients1/55-star benchmark: 98%
Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation
Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) who have an optic nerve head evaluation during one or more office visits within 12 months
99%223 patients4/55-star benchmark: 100%
Provide Patient Access
For at least one unique patient seen by the MIPS eligible clinician: (1) The patient (or the patient authorized representative) is provided timely access to view online, download, and transmit his or her health information; and (2) The MIPS eligible clinician…
96%562 patients4/55-star benchmark: 100%
Use of High-Risk Medications in the Elderly
Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are submitted. 1) Percentage of patients who were ordered at least one high-risk medication.
Lower rates are better for this measure.
Patients 2+: 0% · 709 patients
0%709 patients5/55-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 2

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

Frames, purchases V2020
Other-Vision, Hearing, and Speech Services · category OC000N
2 suppliers18 claims18 services$61.74 avg. paid by Medicare
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens V2203
Other-Vision, Hearing, and Speech Services · category OC000N
1 supplier16 claims26 services$43.25 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES

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

DRS RUBIN AND SIMONIAN PC
Ophthalmology
1421 E. 12 MILE, BLDG. A
MADISON HEIGHTS, MI 48071
Oakland County (248) 547-6656

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 Sidney Simonian's NPI number?

The NPI number for Sidney Simonian is 1902849045. It was assigned to this individual provider in the NPPES registry on June 14, 2006.

Where is Sidney Simonian located?

Sidney Simonian practices at 1421 E. 12 Mile Bldg. A, Madison Heights, MI 48071. The listed phone number is (248) 547-6656.

What is Sidney Simonian's specialty?

The primary specialty registered for this NPI is Ophthalmology with taxonomy code 207W00000X.

Is Sidney Simonian enrolled in Medicare?

Yes. Sidney Simonian is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Sidney Simonian accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company and 6 other insurers list Sidney Simonian as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Sidney Simonian affiliated with any hospitals?

According to CMS data, Sidney Simonian is affiliated with Straith Hospital For Special Surgery and Ascension Macomb Oakland Hosp-Warren Campus.

When was this NPI record last updated?

The NPPES record for Sidney Simonian was last updated on June 3, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.