Derek Moeller, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

17537 Issued in MS

Practice address

208 Country Club Rd
Houston, MS 38851-9326

Phone

(662) 456-3437

Fax

(662) 452-2070

NPI assigned

Sep 26, 2006

Last updated

Oct 11, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• North Ms Emergency Physicians

  • Emergency Medicine Physician
  • Tupelo, MS
  • NPI 1891724035
  NPD (past)

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476144000000",
    "number": "1184725558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1114 COMMONWEALTH BLVD",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388049301",
            "telephone_number": "662-456-3437",
            "fax_number": "662-452-2070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 COUNTRY CLUB RD",
            "city": "HOUSTON",
            "state": "MS",
            "postal_code": "388519326",
            "telephone_number": "662-456-3437",
            "fax_number": "662-452-2070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOELLER",
        "first_name": "DEREK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2016-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "17537",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "MS17537",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00125350",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09013750",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• MCM of Mississippi LLC (houston family pharmacy)
• Med Express of Mississppi
• Mississippi State Department of Health (Tombigbee Home Health Agency 4B)
• Mississippi State Department of Health
• Natalie Mitchell, LCSW
• Laveta Moore
• William Morgan, MD
• MTS Live LLC (MTS Live EMS)
• Anne Millette Nabors
• Joe Nichols

• Internal Medicine Physician in Houston, MS
• Providers in Houston, MS by specialty
• Internal Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.