Basic Information
| Provider Information | |||||||||
| NPI: | 1609898667 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMES | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SIMES | ||||||||
| OtherFirstName: | REBECCA | ||||||||
| OtherMiddleName: | S | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | I | ||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 1460 | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224021460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407862100 | ||||||||
| FaxNumber: | 5407860677 | ||||||||
| Practice Location | |||||||||
| Address1: | 4701 SPOTSYLVANIA PKWY | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224079435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5408345430 | ||||||||
| FaxNumber: | 5408345431 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 02/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 0101102732 | VA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 34113 | 01 | VA | CARENET # | OTHER | 296685 | 01 | VA | OPT CHOICE/MDIPA/MAMSI # | OTHER | 542039043 | 01 | VA | PRIVATE HEALTHCARE SYSTEM | OTHER | 542039043 | 01 | VA | VIRGINIA HEALTH NETWORK # | OTHER | 542039043 | 01 | VA | UNITED HEALTHCARE # | OTHER | 505725 | 01 | VA | NCPPO | OTHER | 542039043 | 01 | VA | CIGNA # | OTHER | 143040 | 01 | VA | SOUTHERN HEALTH # | OTHER | 542039043 | 01 | VA | AETNA # | OTHER | 6701086 | 05 | VA | MEDICAID | 218746 | 01 | VA | ANTHERM BCBS PROVIDER # | OTHER | 296685 | 01 | VA | ALLIANCE NUMBER | OTHER | 40919 | 01 | VA | SENTARA/OPTIMA HEALTH # | OTHER |