Individual provider Active NPI

Gerald W Moritz, MD

  • Otolaryngology Physician
  • Saint Louis, MO
National Provider Identifier
1154418424
Registry record updated Nov 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
32656 Issued in MO
Practice address
11125 Dunn Rd
Ste 201
Saint Louis, MO 63136-6132
Phone
(314) 362-7509
Fax
(314) 362-7522
NPI assigned
Oct 6, 2006
Last updated
Nov 15, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 32656 MO Primary

Addresses

Primary practice location

11125 Dunn Rd
Ste 201
Saint Louis, MO 63136-6132

Mailing address

660 S Euclid Ave
CB 8115
Saint Louis, MO 63110-1010
Phone (314) 362-7509

Other identifiers 1

IdentifierTypeStateIssuer
202102703MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20100126000431 MO Practitioner - Otolaryngology 5092857235 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University CurrentSince Nov 1, 2020 Accepting new patients
Washington University CurrentSince Nov 1, 2020 Accepting new patients
Christian Hospital Northeast- Northwest PastSince Jan 1, 2002 Accepting new patients
Physician Groups LC Past Accepting new patients

Locations

1 Memorial Dr
Alton, IL 62002
Phone (618) 463-7240

1225 Graham Rd
Ste C-1340
Florissant, MO 63031
Phone (314) 953-6093

2630 Highway K
O Fallon, MO 63368
Phone (636) 240-5454

11155 Dunn Rd
Ste 109N
Saint Louis, MO 63136
Phone (314) 837-3784

1 Barnes Hospital Plz
Saint Louis, MO 63110
Phone (314) 362-9170

660 S Euclid Ave
#8115
Saint Louis, MO 63110
Phone (314) 362-7395

11125 Dunn Rd
Ste 201
Saint Louis, MO 63136
Phone (314) 355-5300

Interoperability endpoints

  • FHIR API: https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
  • Direct secure messaging: gmoritz11095@direct.carenet.org

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": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636934400000",
    "number": "1154418424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 S EUCLID AVE",
            "address_2": "CB 8115",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101010",
            "telephone_number": "314-362-7509",
            "fax_number": "314-362-7522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11125 DUNN RD",
            "address_2": "STE 201",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631366132",
            "telephone_number": "314-362-7509",
            "fax_number": "314-362-7522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORITZ",
        "first_name": "GERALD",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-06",
        "last_updated": "2021-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MO",
            "license": "32656",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "202102703",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "11125 Dunn Rd",
            "address_2": "Ste 201",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631366132",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.