NPIMap

Individual provider Active NPI

Joellyn Carol Moore, M.D.

  • Clinical Cardiac Electrophysiology Physician
  • Minneapolis, MN
National Provider Identifier
1235306812
Registry record updated Nov 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
License
57675 Issued in MN
Practice address
920 E 28TH St
Suite 300 - Mr 33300
Minneapolis, MN 55407-1139
Phone
(202) 841-3542
NPI assigned
May 13, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 35.093443 OH
Clinical Cardiac Electrophysiology Physician 207RC0001X 57675 MN Primary

Addresses

Primary practice location

920 E 28TH St
Suite 300 - Mr 33300
Minneapolis, MN 55407-1139

Mailing address

920 E 28TH St
Suite 300 - Mr 33300
Minneapolis, MN 55407-1139
Phone (202) 841-3542

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jmoore265124@excellian.direct.allina.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141204002260 MN Practitioner - Cardiac ElectrophysiologyPractitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 5799824116 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiac ElectrophysiologyAlso: Cardiovascular Disease (Cardiology), Internal Medicine
Education
George Washington University School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Allina Health SystemGroup PAC ID 4587573613, 3,844 clinicians

Practice addresses (Care Compare)

800 E 28TH St
Suite H2100
Minneapolis, MN 55407-3723
Phone (612) 863-3900

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair42

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.093443OHMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System Current Accepting new patients
Allina Health System CurrentSince Jul 28, 2014 Accepting new patients
Allina Health System Past Accepting new patients

Locations

800 E 28th St
#H2100
Minneapolis, MN 55407
Phone (612) 775-3030

800 E 28th St
Minneapolis, MN 55407
Phone (612) 863-3547

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

800 E 28th St
Ste H2100
Minneapolis, MN 55407
Phone (612) 863-3900

Organizations & group practices 3

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 32

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

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1210636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604966400000",
    "number": "1235306812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 E 28TH ST",
            "address_2": "SUITE 300 - MR 33300",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071139",
            "telephone_number": "202-841-3542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 E 28TH ST",
            "address_2": "SUITE 300 - MR 33300",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071139",
            "telephone_number": "202-841-3542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "JOELLYN",
        "middle_name": "CAROL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-13",
        "last_updated": "2020-11-10",
        "certification_date": "2020-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "OH",
            "license": "35.093443",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "MN",
            "license": "57675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmoore265124@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "920 E 28th St",
            "address_2": "Suite 300 - MR 33300",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554071139",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.