Active NPI
Matthew Craig Moss, M.D.
- Student in an Organized Health Care Education/Training Program
- Chicago, IL
National Provider Identifier
1104169150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- 3900200000X
- Practice address
- 2525 S Michigan Ave
Mercy Hospital and Medical Center
Chicago, IL 60616-2333 - Phone
- (312) 567-2011
- NPI assigned
- Mar 28, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 3900200000X | IL | Primary |
Addresses
Primary practice location
2525 S Michigan Ave
Mercy Hospital and Medical Center
Chicago, IL 60616-2333
Mailing address
7353 North Ave. #2F
River Forest, IL 60305
Phone (818) 321-9464
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3900200000X | IL | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1364428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364428800000",
"number": "1104169150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7353 NORTH AVE. #2F",
"city": "RIVER FOREST",
"state": "IL",
"postal_code": "60305",
"telephone_number": "818-321-9464"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2525 S MICHIGAN AVE",
"address_2": "MERCY HOSPITAL AND MEDICAL CENTER",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606162333",
"telephone_number": "312-567-2011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOSS",
"first_name": "MATTHEW",
"middle_name": "CRAIG",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-03-28",
"last_updated": "2013-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "IL",
"license": "3900200000X",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.