Individual provider Active NPI

Benjamin Jon Moreno, MD, PHD

  • Diagnostic Radiology Physician
  • Fort Wayne, IN
National Provider Identifier
1013163526
Registry record updated Mar 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
01070072 Issued in IN
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

Updated by the provider on Mar 5, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
201028590MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, OH2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110701000238 IN Practitioner - Diagnostic RadiologyPractitioner - Interventional Radiology 4789862228 Reassigns benefits to 3 organizations
I20170609001383 OH Practitioner - Diagnostic Radiology 4789862228 Reassigns benefits to 1 organization

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
Fort Wayne Radiology Associates LLCGroup PAC ID 5294624060, 35 clinicians

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

Merit-based Incentive Payment System (MIPS)

Final score
80.28 of 100Reported as group
Quality
77.29
Improvement activities
40
Cost
73.88

Merit-based Incentive Payment System (MIPS)

Final score
85.81 of 100Reported as group
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

OrganizationSpecialtyStatusNew patients
Breast Diagnostic Center, LLC Diagnostic Radiology CurrentSince Apr 1, 2017 Accepting new patients
Community Hospitals and Wellness Centers CurrentSince Mar 16, 2021 Accepting new patients
Fort Wayne Radiology Associates LLC Diagnostic Radiology CurrentSince Apr 1, 2017 Accepting new patients
P.E.T. Imaging Services, LLC Diagnostic Radiology CurrentSince Apr 1, 2017 Accepting new patients
Community Hospitals and Wellness Centers CurrentSince Mar 16, 2021 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

  • Direct secure messaging: 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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

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

Verify at the official NPI Registry.