Active NPI
Jacob Layne Moe, D.O.
- Endocrinology, Diabetes & Metabolism Physician
- Farmington Hills, MI
National Provider Identifier
1043574478
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endocrinology, Diabetes & Metabolism Physician
- License
- 5101019711
- Practice address
- 32255 Northwestern Hwy Ste 214
Farmington Hills, MI 48334 - Phone
- (248) 855-5620
- Fax
- (248) 855-5628
- NPI assigned
- Jun 29, 2012
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 5101019711 | MI | |
| Internal Medicine Physician | 207R00000X | 5315054293 | MI | |
| Endocrinology, Diabetes & Metabolism Physician | 207RE0101X | 5101019711 | MI | Primary |
Addresses
Primary practice location
32255 Northwestern Hwy Ste 214
Farmington Hills, MI 48334
Mailing address
29992 Northwestern Hwy Ste C
Farmington Hills, MI 48334-3292
Phone (248) 851-1430
Other practice location 1
358 Mowbray Arch
#203
Norfolk, VA 23507-2219
Phone (757) 446-6190
Other practice location 2
855 W Brambleton Ave
Norfolk, VA 23510-1005
Phone (757) 446-6190
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043574478 | Medicaid | MI | |
| MI4989641 | Other | MI | MEDICARE PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
32255 Northwestern Hwy
Suite 214
Farmington Hills, MI 48334-1573
Phone (248) 855-5620
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5315054293 | MI | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Michigan Healthcare Professionals PC | Internal Medicine | Current | Accepting new patients |
| Michigan Healthcare Professionals PC | Current | Accepting new patients |
Locations
32255 Northwestern Hwy
Ste 214
Farmington Hills, MI 48334
Phone (248) 855-5620
27900 Grand River Ave
Ste 220
Farmington Hills, MI 48336
Phone (248) 477-0552
29992 Northwestern Hwy
Ste C
Farmington Hills, MI 48334
Phone (248) 851-1430
1221 Pine Grove Ave
Port Huron, MI 48060
Phone (810) 989-3300
Organizations & group practices 2
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.
-
- Internal Medicine Physician
- Farmington Hills, MI
- NPI 1295023547
-
- Durable Medical Equipment & Medical Supplies
- Lapeer, MI
- NPI 1992693303
Hospital & facility affiliations 14
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Farmington Hills, MI
- NPI 1336183367
-
- General Acute Care Hospital
- Dearborn, MI
- NPI 1740230119
-
- General Acute Care Hospital
- Pontiac, MI
- NPI 1053356352
-
- General Acute Care Hospital
- Troy, MI
- NPI 1306825997
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340928000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1575590400000",
"number": "1043574478",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29992 NORTHWESTERN HWY STE C",
"city": "FARMINGTON HILLS",
"state": "MI",
"postal_code": "483343292",
"telephone_number": "248-851-1430",
"fax_number": "248-851-5319"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "32255 NORTHWESTERN HWY STE 214",
"city": "FARMINGTON HILLS",
"state": "MI",
"postal_code": "48334",
"telephone_number": "248-855-5620",
"fax_number": "248-855-5628"
}
],
"practiceLocations": [
{
"address_1": "358 Mowbray Arch",
"address_2": "#203",
"address_purpose": "LOCATION",
"city": "Norfolk",
"state": "VA",
"postal_code": "235072219",
"country_code": "US",
"telephone_number": "757-446-6190",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "855 W Brambleton Ave",
"address_purpose": "LOCATION",
"city": "Norfolk",
"state": "VA",
"postal_code": "235101005",
"country_code": "US",
"telephone_number": "757-446-6190",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MOE",
"first_name": "JACOB",
"middle_name": "LAYNE",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-06-29",
"last_updated": "2019-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MI",
"license": "5101019711",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MI",
"license": "5315054293",
"primary": false
},
{
"code": "207RE0101X",
"taxonomy_group": "",
"desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
"state": "MI",
"license": "5101019711",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1043574478",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "MI4989641",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Farmington Hills, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2019; 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.