Active NPI
Benjamin Jon Moreno, MD, PHD
- Diagnostic Radiology Physician
- Fort Wayne, IN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 01070072
- Practice address
- 3707 New Vision Dr Ste 110
Fort Wayne, IN 46845-1702 - Phone
- (260) 469-6602
- Fax
- (260) 484-5919
- NPI assigned
- Aug 15, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular & Interventional Radiology Physician | 2085R0204X | 01070072 | IN | |
| Diagnostic Radiology Physician | 2085R0202X | 01070072 | IN | Primary |
Addresses
Primary practice location
3707 New Vision Dr Ste 110
Fort Wayne, IN 46845-1702
Mailing address
3707 New Vision Dr
Fort Wayne, IN 46845-1702
Phone (260) 469-6602
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201028590 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN, OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Diagnostic Radiology
- Education
- University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
121 Westfield Dr
Archbold, OH 43502-1056
Phone (419) 445-4415
2200 Randallia Dr
Fort Wayne, IN 46805-4638
Phone (260) 373-4000
Hospital & facility affiliations
- Parkview Regional Medical Center
- Parkview Whitley Hospital
- Parkview Dekalb Hospital
- Parkview Huntington Hospital
- Parkview Wabash Hospital, Inc
Merit-based Incentive Payment System (MIPS)
- Final score
- 80.28 of 100
- Quality
- 77.29
- Improvement activities
- 40
- Cost
- 73.88
Merit-based Incentive Payment System (MIPS)
- Final score
- 85.81 of 100
- Quality
- 80.59
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 72.11
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine, Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Breast Diagnostic Center, LLC | Diagnostic Radiology | Current | Accepting new patients |
| Community Hospitals and Wellness Centers | Current | Accepting new patients | |
| Fort Wayne Radiology Associates LLC | Diagnostic Radiology | Current | Accepting new patients |
| P.E.T. Imaging Services, LLC | Diagnostic Radiology | Current | Accepting new patients |
| Community Hospitals and Wellness Centers | Current | Accepting new patients |
Locations
3270 Intertech Dr
Angola, IN 46703
Phone (260) 305-2622
2110 Carew St
Fort Wayne, IN 46805
Phone (219) 432-6710
2200 Randallia Dr
Fort Wayne, IN 46805
Phone (260) 373-4000
1818 Carew St
Ste 40
Fort Wayne, IN 46805
Phone (219) 483-1847
3707 New Vision Dr
Ste 110
Fort Wayne, IN 46845
3707 New Vision Dr
Fort Wayne, IN 46845
Phone (260) 373-4000
1818 Carew St
Ste 30
Fort Wayne, IN 46805
Phone (260) 425-5900
2620 S Western Ave
Marion, IN 46953
Phone (765) 573-2530
121 Westfield Dr
Archbold, OH 43502
Phone (419) 445-2015
433 W High St
Bryan, OH 43506
Phone (419) 636-1131
909 E Snyder Ave
Montpelier, OH 43543
Phone (419) 485-3154
1035 W Wayne St
Paulding, OH 45879
Phone (419) 399-4080
Interoperability endpoints
- bmoreno117173@direct.parkviewexchange.com
Organizations & group practices 5
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Diagnostic Radiology Physician
- Fort Wayne, IN
- NPI 1790748499
-
- Diagnostic Radiology Physician
- Fort Wayne, IN
- NPI 1992768691
-
- General Practice Physician
- Bryan, OH
- NPI 1225167893
-
- Medicare Defined Swing Bed Hospital Unit
- Montpelier, OH
- NPI 1386687218
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Auburn, IN
- NPI 1902897937
-
- General Acute Care Hospital
- Huntington, IN
- NPI 1003821729
-
- General Acute Care Hospital
- Fort Wayne, IN
- NPI 1366407603
-
- Critical Access Hospital
- Wabash, IN
- NPI 1245259878
-
- General Acute Care Hospital
- Columbia City, IN
- NPI 1205844495
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1614902400000",
"number": "1013163526",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3707 NEW VISION DR",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468451702",
"telephone_number": "260-469-6602",
"fax_number": "260-484-5919"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3707 NEW VISION DR STE 110",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468451702",
"telephone_number": "260-469-6602",
"fax_number": "260-484-5919"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORENO",
"first_name": "BENJAMIN",
"middle_name": "JON",
"name_prefix": "Dr.",
"credential": "MD, PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-08-15",
"last_updated": "2021-03-05",
"certification_date": "2021-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0204X",
"taxonomy_group": "",
"desc": "Radiology, Vascular & Interventional Radiology",
"state": "IN",
"license": "01070072",
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "IN",
"license": "01070072",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201028590",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.