Individual provider Active NPI

William James Moran, M.D.

  • Family Medicine Physician
  • Austin, TX
National Provider Identifier
1114922325
Registry record updated May 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
E4547 Issued in TX
Practice address
4201 Marathon Blvd
Suite 204
Austin, TX 78756-3436
Phone
(512) 459-3205
Fax
(512) 459-8590
NPI assigned
Jun 15, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 30, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X E4547 TX Primary

Addresses

Primary practice location

4201 Marathon Blvd
Suite 204
Austin, TX 78756-3436

Mailing address

4201 Marathon Blvd
Suite 204
Austin, TX 78756-3436
Phone (512) 459-3205

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20090924000308 TX Practitioner - General PracticePractitioner - Family Practice 2860548310 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Health and Human Services Commission Current Accepting new patients
Health and Human Services Commission CurrentSince Jul 2, 2021 Accepting new patients
Health and Human Services Commission CurrentSince Jul 2, 2021 Accepting new patients

Locations

805 N Dickinson Dr
Rusk, TX 75785
Phone (903) 683-7201

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212105600000",
    "number": "1114922325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 MARATHON BLVD",
            "address_2": "SUITE 204",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787563436",
            "telephone_number": "512-459-3205",
            "fax_number": "512-459-8590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 MARATHON BLVD",
            "address_2": "SUITE 204",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787563436",
            "telephone_number": "512-459-3205",
            "fax_number": "512-459-8590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORAN",
        "first_name": "WILLIAM",
        "middle_name": "JAMES",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-15",
        "last_updated": "2008-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "E4547",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

Verify at the official NPI Registry.