NPIMap

Individual provider Active NPI

Santiago Fabian Moscoso Martinez, M.D.

  • Hematology & Oncology Physician
  • Midland, MI
National Provider Identifier
1154619021
Registry record updated Mar 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
4301510406 Issued in MI
Practice address
4201 Campus Ridge Dr
Midland, MI 48640-6128
Phone
(989) 839-6188
Fax
(989) 839-6221
NPI assigned
Jul 13, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X 4301510406 MI Primary
Hematology & Oncology Physician 207RH0003X 44063 IA
Hematology & Oncology Physician 207RH0003X 30205 NE

Addresses

Primary practice location

4201 Campus Ridge Dr
Midland, MI 48640-6128

Mailing address

4000 Wellness Dr
Midland, MI 48670-2000
Phone (844) 832-1956

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR, MI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210915001761 AR Practitioner - Hematology/Oncology 6406127810 Reassigns benefits to 1 organization
I20240129000497 MI Practitioner - Hematology/Oncology 6406127810 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mymichigan Medical Center MidlandGroup PAC ID 2264323633, 507 clinicians
Mymichigan Medical Center AlpenaGroup PAC ID 8527969922, 97 clinicians

Practice addresses (Care Compare)

4201 Campus Ridge Dr
Midland, MI 48640-6128
Phone (989) 837-9071

621 Court St
Suite 105
West Branch, MI 48661-8768
Phone (989) 343-3750

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
44063IAMDHematology & Oncology Physician
30205NEMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cancer Care Associates Inc Hematology & Oncology CurrentSince Oct 1, 2021 Accepting new patients
Mymichigan Medical Center Midland CurrentSince Jul 23, 2025 Accepting new patients
West Branch Regional Medical Center Current Accepting new patients
Mymichigan Medical Center Alpena CurrentSince Mar 4, 2024 Accepting new patients
Mymichigan Medical Center Midland CurrentSince Jul 23, 2025 Accepting new patients
Mymichigan Medical Center West Branch Current Accepting new patients
Mymichigan Medical Center West Branch CurrentSince Jun 10, 2025 Accepting new patients
Mymichigan Medical Center Alpena Hematology & Oncology CurrentSince Mar 4, 2024 Accepting new patients

Locations

225 E Washington Ave
Jonesboro, AR 72401
Phone (870) 207-1630

225 E Jackson Ave
Jonesboro, AR 72401
Phone (870) 207-1630

315 E Warwick Dr
Ste C
Alma, MI 48801
Phone (989) 463-9300

1501 W Chisholm St
Alpena, MI 49707
Phone (989) 356-7000

609 Quarter St
Gladwin, MI 48624
Phone (989) 246-6371

4000 Wellness Dr
Midland, MI 48670
Phone (844) 832-1956

4201 N Campus Ridge Dr
Midland, MI 48640
Phone (989) 488-5450

4500 N Campus Ridge Dr
Midland, MI 48640
Phone (989) 837-9250

621 Court St
Ste 105
West Branch, MI 48661
Phone (989) 343-3750

2463 S M 30
West Branch, MI 48661
Phone (517) 345-3660

Interoperability endpoints

  • Direct secure messaging: santiago.moscoso@nylencancercenter.ikm.direct-ci.com
  • Direct secure messaging: smoscosomartinez145809@mymichiganhealth.midirect.net

Organizations & group practices 8

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.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1310515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709596800000",
    "number": "1154619021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 WELLNESS DR",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486702000",
            "telephone_number": "844-832-1956",
            "fax_number": "989-633-5241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 CAMPUS RIDGE DR",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486406128",
            "telephone_number": "989-839-6188",
            "fax_number": "989-839-6221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSCOSO MARTINEZ",
        "first_name": "SANTIAGO",
        "middle_name": "FABIAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-13",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "MI",
            "license": "4301510406",
            "primary": true
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "IA",
            "license": "44063",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NE",
            "license": "30205",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Midland, MI

Sources for this page

Verify at the official NPI Registry.