Physician Compare National (NPI:1578556601)

HEALTHCARE PROVIDER: DONALD RAE SIMMONS MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1578556601
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4082526991
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150630000888
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SIMMONS
	Individual professional last name
Provider First Name	DONALD
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	UNIVERSITY OF OKLAHOMA COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1999
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	BALANCE FAMILY PRACTICE AND MEDICAL SPA LLC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	6901152776
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1230 W MAIN ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE B
	Group Practice or individual's line 2 address
City	PAWHUSKA
	Group Practice or individual's city
State	OK
	Group Practice or individual's state
Zip Code	740565911
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9187104112
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	370018
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	JANE PHILLIPS MEMORIAL MEDICAL CENTER, INC
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	451343
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ELECTRA MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	371323
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	WEATHERFORD REGIONAL HOSPITAL, INC OF WEATHERFORD
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y