TIMOTHY ROBERT SIMIC (NURSE PRACTITIONER) – Family Nurse Practitioner, NPI 1053904896

TIMOTHY ROBERT SIMIC (NURSE PRACTITIONER) is a healthcare provider. based in Louisville, Kentucky. specializing in NURSE PRACTITIONER. They hold the professional credentials NURSE PRACTITIONER. They hold a License No. 1102450 (KY). The NPI Number for TIMOTHY ROBERT SIMIC (NURSE PRACTITIONER) is 1053904896

Main info

Male
Sole Proprietor
22 Years Of Experience
Name
TIMOTHY ROBERT SIMIC (NURSE PRACTITIONER)
NPI
1053904896
Phone
(502) 558-9325
Address
3800 ORMOND RD
Enumeration Date
12 February 2021
Last Update Date
17 March 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5026572701
Graduation Year
2004 (22 years ago)
PAC ID
7618480708
Group Practice PAC ID
4486909769
Professional Enrollment ID
I20250701004195
Address ID
KY402583952LO6801XHWYX301
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience43
Completeness75
Years active:5State licenses:2Digital endpointsOther names

7,347 NURSE PRACTITIONER in KY

Provider Addresses for TIMOTHY ROBERT SIMIC (NURSE PRACTITIONER)

  • 3800 ORMOND RD

    LOUISVILLE, KY 402071903

    Phone: (502) 558-9325

    Type: Mailing

  • 1357 BARDSTOWN RD

    LOUISVILLE, KY 402041353

    Phone: (502) 897-6443

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2025-07-01

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20250701004195INurse PractitionerKYTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 40207)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4486909769View full group profile
NameSpecialtyState
Nurse PractitionerOH
Internal MedicineKY
-KY
Clinical Social WorkerKY
Nurse PractitionerKY
-OH
Nurse PractitionerKY
Mental Health CounselorOH
Nurse PractitionerKY
-KY

Reviews

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Frequently asked questions

What identifier follows TIMOTHY ROBERT SIMIC (NURSE PRACTITIONER) across health systems?
The NPI 1053904896 uniquely identifies TIMOTHY ROBERT SIMIC (NURSE PRACTITIONER) in U.S. healthcare data.
Does the public listing show TIMOTHY ROBERT SIMIC (NURSE PRACTITIONER) as active?
TIMOTHY ROBERT SIMIC (NURSE PRACTITIONER)'s NPI record reflects an active status in NPPES.
How should patients interpret TIMOTHY ROBERT SIMIC (NURSE PRACTITIONER)'s specialty?
The extract shows Family Nurse Practitioner for TIMOTHY ROBERT SIMIC (NURSE PRACTITIONER). Clinical services aligned with this taxonomy classification.
Which community is linked to TIMOTHY ROBERT SIMIC (NURSE PRACTITIONER)?
TIMOTHY ROBERT SIMIC (NURSE PRACTITIONER) shows a connection to Louisville, Kentucky in registry-derived data.
Who maintains TIMOTHY ROBERT SIMIC (NURSE PRACTITIONER)'s record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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