Provider Demographics
NPI:1083818561
Name:SIMMONS, ALAN J (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:J
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 W MEDICAL CENTER DR
Mailing Address - Street 2:MOB A102
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8419
Mailing Address - Country:US
Mailing Address - Phone:815-338-6600
Mailing Address - Fax:
Practice Address - Street 1:4309 W MEDICAL CENTER DR
Practice Address - Street 2:MOB A102
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8419
Practice Address - Country:US
Practice Address - Phone:815-338-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY43972207R00000X
TN45612207R00000X, 208M00000X
IL036136647208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000695031OtherANTHEM-CMA
KY000057094UOtherHUMANA-CMA
TN4321218OtherBLUE CROSS-BLUE SHIELD
TN1527128Medicaid
KY7100149020Medicaid
KY50031519OtherPASSPORT-CMA
KY122637OtherSIHO-CMA
KY2400911OtherCIGNA-CMA
IN201013040Medicaid
TNP01027597OtherRR MEDICARE
KY000057094UOtherHUMANA-CMA
KY2400911OtherCIGNA-CMA