Active NPI
Donnie Jay Moreno I
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- Pasadena, CA
National Provider Identifier
1093584815
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- License
- 1051707
- Practice address
- 462 Prescott St
Pasadena, CA 91104-2858 - Phone
- (626) 485-2635
- NPI assigned
- Dec 20, 2023
- 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 |
|---|---|---|---|---|
| Wound Care Registered Nurse | 163WW0000X | 8CB9E | CA | |
| Rehabilitation Practitioner | 225400000X | 1051707 | CA | |
| Sports Medicine (Physical Medicine & Rehabilitation) Physician | 2081S0010X | 1051707 | CA | Primary |
Addresses
Primary practice location
462 Prescott St
Pasadena, CA 91104-2858
Mailing address
221 Fremont Ave
South Pasadena, CA 91030
Phone (626) 485-2635
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1051707 | Medicaid | CA | |
| 8CB9E | Other | CA | BASIC LIFE SUPPORT |
Other names 1
- Mr. John Greenewald Jr.
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8CB9E | CA | MD | Wound Care Registered Nurse |
| 1051707 | CA | MD | Sports Medicine (Physical Medicine & Rehabilitation) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1703030400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706486400000",
"number": "1093584815",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "221 FREMONT AVE",
"city": "SOUTH PASADENA",
"state": "CA",
"postal_code": "91030",
"telephone_number": "626-485-2635"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "462 PRESCOTT ST",
"city": "PASADENA",
"state": "CA",
"postal_code": "911042858",
"telephone_number": "626-485-2635"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORENO",
"first_name": "DONNIE",
"middle_name": "JAY",
"name_suffix": "I",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-12-20",
"last_updated": "2024-01-29",
"certification_date": "2024-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "163WW0000X",
"taxonomy_group": "",
"desc": "Registered Nurse, Wound Care",
"state": "CA",
"license": "8CB9E",
"primary": false
},
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "CA",
"license": "1051707",
"primary": false
},
{
"code": "2081S0010X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation, Sports Medicine",
"state": "CA",
"license": "1051707",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1051707",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BASIC LIFE SUPPORT",
"identifier": "8CB9E",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JOHN",
"last_name": "GREENEWALD",
"prefix": "MR.",
"suffix": "JR.",
"credential": "FIOA/PA FOIA/PA",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.