Dr Jacob C Simon, DDS is a medicare enrolled "Student In An Organized Health Care Education/training Program" provider in Farmington, Connecticut. His current practice location is
263 Farmington Ave, Farmington, Connecticut. You can reach out to his office (for appointments etc.) via phone at
(860) 679-2000.
Dr Jacob C Simon is licensed to practice in Connecticut (license number 13111) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1396346912.
Healthcare Provider's Profile
| Full Name | Dr Jacob C Simon |
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| Gender | Male |
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| Speciality | Student In An Organized Health Care Education/training Program |
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| Location | 263 Farmington Ave, Farmington, Connecticut |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1396346912
- Provider Enumeration Date: 11/02/2020
- Last Update Date: 06/02/2021
Medicare PECOS Information:
- PECOS PAC ID: 2466856257
- Enrollment ID: I20210802000140
Medical Identifiers
Medical identifiers for Dr Jacob C Simon such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1396346912 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 1223G0001X | Dentist - General Practice | 13034 (Connecticut) | Secondary |
| 1223G0001X | Dentist - General Practice | 105764 (California) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | 13111 (Connecticut) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Jacob C Simon is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Jacob C Simon, DDS
1708 Franklin St,
Oakland, CA 94612-3408
Ph: () - | Dr Jacob C Simon, DDS
263 Farmington Ave,
Farmington, CT 06030-3408
Ph: (860) 679-2000 |
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