Keith a. Moss, M.D., SC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036105851 Issued in IL

Legal business name

KEITH A. MOSS, M.D., SC

Practice address

300 Riverside Dr
Suite 2400
Bourbonnais, IL 60914-4996

Phone

(815) 935-2784

Fax

(815) 935-5687

NPI assigned

Jul 11, 2007

Organization subpart

No

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

Authorized official

Name

Keith A. Moss, M.D.

Title

President

Phone

(815) 935-2784

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1184112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211932800000",
    "number": "1154520112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 RIVERSIDE DR",
            "address_2": "SUITE 2400",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609144996",
            "telephone_number": "815-935-2784",
            "fax_number": "815-935-5687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 RIVERSIDE DR",
            "address_2": "SUITE 2400",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609144996",
            "telephone_number": "815-935-2784",
            "fax_number": "815-935-5687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEITH A. MOSS, M.D., SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-11",
        "last_updated": "2008-05-28",
        "status": "A",
        "authorized_official_last_name": "MOSS",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-935-2784",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036105851",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036105851",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Bourbonnais, IL
• Providers in Bourbonnais, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.