Individual provider Active NPI

Kevin Bryant Moss

  • Physical Medicine & Rehabilitation Physician
  • Solon, OH
National Provider Identifier
1104438035
Registry record updated Aug 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
PT018880 Issued in OH
Practice address
6050 Enterprise Pkwy
Solon, OH 44139-2762
Phone
(440) 519-1008
NPI assigned
Aug 21, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X PT018880 OH Primary

Addresses

Primary practice location

6050 Enterprise Pkwy
Solon, OH 44139-2762

Mailing address

6050 Enterprise Pkwy
Solon, OH 44139-2762

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210819002916 OH Practitioner - Physical Therapist in Private Practice 9931504545 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT018880OHMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Novacare Rehabilitation of Ohio, Inc. CurrentSince Jun 1, 2021 Accepting new patients
Brahms, Cohn & Leb, Inc CurrentSince Dec 15, 2022 Accepting new patients
Novacare Rehabilitation of Ohio, Inc. CurrentSince Jun 1, 2021 Accepting new patients
Novacare Rehabilitation of Ohio Inc PastSince Aug 23, 2020 Accepting new patients

Locations

23250 Mercantile Rd
Ste 100
Beachwood, OH 44122
Phone (216) 825-0203

803 E Washington St
Ste 130
Medina, OH 44256
Phone (330) 725-4200

6050 Enterprise Pkwy
Solon, OH 44139
Phone (440) 519-1008

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": "1597968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597968000000",
    "number": "1104438035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6050 ENTERPRISE PKWY",
            "city": "SOLON",
            "state": "OH",
            "postal_code": "441392762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6050 ENTERPRISE PKWY",
            "city": "SOLON",
            "state": "OH",
            "postal_code": "441392762",
            "telephone_number": "440-519-1008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSS",
        "first_name": "KEVIN",
        "middle_name": "BRYANT",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-21",
        "last_updated": "2020-08-21",
        "certification_date": "2020-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "OH",
            "license": "PT018880",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Solon, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.