NPIMap

Individual provider Active NPI

Kenneth K Moghadam, M.D.

  • Reproductive Endocrinology Physician
  • Carmel, IN
National Provider Identifier
1033120282
Registry record updated Apr 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Reproductive Endocrinology PhysicianTaxonomy code 207VE0102X
License
01051029A Issued in IN
Practice address
11725 N Illinois St
Suite 515
Carmel, IN 46032-3008
Phone
(317) 814-4110
Fax
(317) 814-4114
NPI assigned
Aug 11, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 30, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Reproductive Endocrinology Physician 207VE0102X 01051029A IN Primary

Addresses

Primary practice location

11725 N Illinois St
Suite 515
Carmel, IN 46032-3008

Mailing address

11725 N Illinois St
Suite 515
Carmel, IN 46032-3008
Phone (317) 814-4110

Other identifiers 1

IdentifierTypeStateIssuer
000000366889OtherINANTHEM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01051029AINMDReproductive Endocrinology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Greater Cincinnati OB/GYN, Inc. Reproductive Endocrinology Past Accepting new patients
Austin Fertility Institute, PA Reproductive Endocrinology Past Accepting new patients
Greater Cincinnati Perinatal Associates, LLC Past Accepting new patients
Major Hospital Past Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1272585600000",
    "number": "1033120282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11725 N ILLINOIS ST",
            "address_2": "SUITE 515",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460323008",
            "telephone_number": "317-814-4110",
            "fax_number": "317-814-4114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11725 N ILLINOIS ST",
            "address_2": "SUITE 515",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460323008",
            "telephone_number": "317-814-4110",
            "fax_number": "317-814-4114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOGHADAM",
        "first_name": "KENNETH",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2010-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VE0102X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Reproductive Endocrinology",
            "state": "IN",
            "license": "01051029A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000366889",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carmel, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.