Individual provider Active NPI

Patrick J Moen, MD

  • Orthopaedic Surgery Physician
  • Saint Louis, MO
National Provider Identifier
1063893220
Registry record updated Oct 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
2022034935 Issued in MO
Practice address
11125 Dunn Rd Ste 301
Saint Louis, MO 63136-6132
Phone
(314) 953-8250
NPI assigned
Jun 13, 2015
Last updated
Oct 25, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X ME148643 FL
Orthopaedic Surgery Physician 207X00000X 2022034935 MO Primary

Addresses

Primary practice location

11125 Dunn Rd Ste 301
Saint Louis, MO 63136-6132

Mailing address

11125 Dunn Rd Ste 301
Saint Louis, MO 63136-6132
Phone (314) 953-8250

Other practice location 1

13020 N Telecom Pkwy
Temple Terrace, FL 33637-0925
Phone (813) 978-9700

Other practice location 2

3635 Vista Ave
Saint Louis, MO 63110-2539
Phone (314) 577-8317

Other identifiers 1

IdentifierTypeStateIssuer
ME148643OtherFLSTATE LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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 1

Enrollment IDStateProvider typePAC IDDetails
I20221108000779 MO Practitioner - Orthopedic Surgery 7113229667 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Wayne State University School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physician Groups LCGroup PAC ID 3072421254, 526 clinicians

Practice addresses (Care Compare)

11125 Dunn Rd
Suite 301
Saint Louis, MO 63136-6132
Phone (314) 953-8250

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)11

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Groups LC CurrentSince Nov 1, 2022 Accepting new patients
Physician Groups LC CurrentSince Nov 1, 2022 Accepting new patients

Locations

1225 Graham Rd
Ste 1220B
Florissant, MO 63031
Phone (314) 953-8250

2630 Highway K
O Fallon, MO 63368
Phone (636) 240-5454

11125 Dunn Rd
Ste 301
Saint Louis, MO 63136
Phone (314) 741-6864

Interoperability endpoints

  • Direct secure messaging: patrick.moen.1@18802.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1434153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666656000000",
    "number": "1063893220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11125 DUNN RD STE 301",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631366132",
            "telephone_number": "314-953-8250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11125 DUNN RD STE 301",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631366132",
            "telephone_number": "314-953-8250"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13020 N Telecom Pkwy",
            "address_purpose": "LOCATION",
            "city": "Temple Terrace",
            "state": "FL",
            "postal_code": "336370925",
            "country_code": "US",
            "telephone_number": "813-978-9700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3635 Vista Ave",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631102539",
            "country_code": "US",
            "telephone_number": "314-577-8317",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOEN",
        "first_name": "PATRICK",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-13",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "FL",
            "license": "ME148643",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MO",
            "license": "2022034935",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "ME148643",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "11125 Dunn Rd Ste 301",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631366132",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.