Basic Information
| Provider Information | |||||||||
| NPI: | 1083818561 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMMONS | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4309 W MEDICAL CENTER DR | ||||||||
| Address2: | MOB A102 | ||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600508419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153386600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4309 W MEDICAL CENTER DR | ||||||||
| Address2: | MOB A102 | ||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600508419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153386600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 43972 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 45612 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 45612 | TN | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 036136647 | IL | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 000000695031 | 01 | KY | ANTHEM-CMA | OTHER | 000057094U | 01 | KY | HUMANA-CMA | OTHER | 4321218 | 01 | TN | BLUE CROSS-BLUE SHIELD | OTHER | 1527128 | 05 | TN | MEDICAID | 7100149020 | 05 | KY | MEDICAID | 50031519 | 01 | KY | PASSPORT-CMA | OTHER | 122637 | 01 | KY | SIHO-CMA | OTHER | 2400911 | 01 | KY | CIGNA-CMA | OTHER | 201013040 | 05 | IN | MEDICAID | P01027597 | 01 | TN | RR MEDICARE | OTHER |