Active NPI
David R Moss, M.D.
- Psychiatry Physician
- Jacksonville, FL
National Provider Identifier
1144511700
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128b(4) exclusion effective Oct 19, 2017.
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- ME45122
- Practice address
- 1200 Riverplace Blvd
Suite: 620
Jacksonville, FL 32207-9046 - Phone
- (904) 396-6620
- Fax
- (904) 396-6528
- NPI assigned
- Apr 29, 2011
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | ME0045122 | FL | |
| Psychiatry Physician | 2084P0800X | ME45122 | FL | Primary |
Addresses
Primary practice location
1200 Riverplace Blvd
Suite: 620
Jacksonville, FL 32207-9046
Mailing address
1200 Riverplace Blvd
Suite: 620
Jacksonville, FL 32207-9046
Phone (904) 396-6620
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6609848 | Other | FL | AETNA CHOICE POS |
| 2164947 | Other | FL | CIGNA |
| 260335700 | Medicaid | FL | |
| 27356163700 | Other | OH | OHIO BUREAU OF WORKERS COMPENSATION |
| 694322 | Other | FL | VALUE OPTIONS |
| N614194 | Other | FL | WELLCARE |
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Inpatient Consultants of Florida, Inc | Psychiatry | Past | Accepting new patients |
| Tracy Riley Counseling LLC | Past | Accepting new patients | |
| Southeastern Neuroscience Institute PA | Specialist | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Internal Medicine Physician
- Orange Park, FL
- NPI 1396795597
Psychiatry
-
- Specialist
- Jacksonville, FL
- NPI 1700099017
-
- Community/Behavioral Health Agency
- Jacksonville, FL
- NPI 1306234950
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1304035200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1362355200000",
"number": "1144511700",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 RIVERPLACE BLVD",
"address_2": "SUITE: 620",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322079046",
"telephone_number": "904-396-6620",
"fax_number": "904-396-6528"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 RIVERPLACE BLVD",
"address_2": "SUITE: 620",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322079046",
"telephone_number": "904-396-6620",
"fax_number": "904-396-6528"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOSS",
"first_name": "DAVID",
"middle_name": "R",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-04-29",
"last_updated": "2013-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "FL",
"license": "ME0045122",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "FL",
"license": "ME45122",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA CHOICE POS",
"identifier": "6609848",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "2164947",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "260335700",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OHIO BUREAU OF WORKERS COMPENSATION",
"identifier": "27356163700",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "694322",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE",
"identifier": "N614194",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.