John Lindsay Moody, MD

Primary specialty

Psychosomatic Medicine PhysicianTaxonomy code 2084P0015X

License

MD00016542 Issued in WA

Practice address

24961 Thompson Dr
Sedro Woolley, WA 98284-8246

Phone

(360) 856-3115

NPI assigned

Apr 10, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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 and National Provider Directory roles.

• Pioneer Human Services

  • Substance Abuse Rehabilitation Facility
  • Bellingham, WA
  • NPI 1003201732
  NPD (past)
• Pioneer Human Services

  • Substance Abuse Rehabilitation Facility
  • Sedro-Woolley, WA
  • NPI 1073739207
  NPD (past)

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1194948117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4315 SHELBY CT",
            "city": "ANACORTES",
            "state": "WA",
            "postal_code": "982218773",
            "telephone_number": "360-299-8303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24961 THOMPSON DR",
            "city": "SEDRO WOOLLEY",
            "state": "WA",
            "postal_code": "982848246",
            "telephone_number": "360-856-3115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOODY",
        "first_name": "JOHN",
        "middle_name": "LINDSAY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0015X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychosomatic Medicine",
            "state": "WA",
            "license": "MD00016542",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DSHS PROVER NUMBER",
            "identifier": "1045046",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Paul Minor
• Anita Mitcham, RN
• Chelle Lynne Moat, M.D.
• Dante Jospeh Moceri
• David Matthew Moena
• Allya Elizabeth Moore, LMT
• Kimberly Moore, RN
• Michelle Rae Moore, MA, LMHC, NCC
• Shannon L Moore, LPN
• Susan Marie Moore, CCSH, RPSGT

• Psychosomatic Medicine Physician in Sedro Woolley, WA
• Providers in Sedro Woolley, WA by specialty
• Psychosomatic Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.