Individual provider Active NPI

Adrian M Moran, MD

  • Pediatric Cardiology Physician
  • Milwaukee, WI
National Provider Identifier
1255301974
Registry record updated Nov 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
22611 Issued in WI
Practice address
2801 W Kinnickinnic River Pkwy
Milwaukee, WI 53215-3669
Phone
(414) 649-3370
NPI assigned
Jan 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Cardiology Physician 2080P0202X 016355 ME
Pediatric Cardiology Physician 2080P0202X MD16355 ME
Pediatric Cardiology Physician 2080P0202X 22611 WI Primary

Addresses

Primary practice location

2801 W Kinnickinnic River Pkwy
Milwaukee, WI 53215-3669

Mailing address

3301 W Forest Home Ave
Milwaukee, WI 53215-2843
Phone (414) 649-3370

Other practice location 1

71 US Route 1
Suite C
Scarborough, ME 04074-7173
Phone (207) 883-5532

Other identifiers 1

IdentifierTypeStateIssuer
292420099MedicaidME

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/
Direct Messaging Address amoran348197@direct.myadvocateaurora.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
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

Enrollment IDStateProvider typePAC IDDetails
I20040616000484 ME Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Pediatric MedicinePractitioner - Internal Medicine 0941284020 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
016355MEMDPediatric Cardiology Physician
22611WIMDPediatric Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Maine Medical Partners Pediatric Cardiology CurrentSince Feb 24, 2019 Accepting new patients
Central Maine Medical Center CurrentSince Mar 1, 2020 Accepting new patients
Maine Medical Partners Current Accepting new patients
St. Mary's Regional Medical Center CurrentSince Nov 11, 2019 Accepting new patients
St. Mary's Regional Medical Center CurrentSince Nov 11, 2019 Accepting new patients
Central Maine Medical Center CurrentSince Mar 1, 2020 Accepting new patients
Maine Medical Partners CurrentSince Feb 24, 2019 Accepting new patients

Locations

791 Turner St
#2
Auburn, ME 04210
Phone (207) 330-3900

300 Main St
Lewiston, ME 04240
Phone (207) 795-2400

93 Campus Ave
#I2
Lewiston, ME 04240
Phone (207) 777-4420

93 Campus Ave
Lewiston, ME 04240
Phone (207) 755-3715

22 Bramhall St
Portland, ME 04102
Phone (207) 662-2179

887 Congress St
Ste 200
Portland, ME 04102
Phone (207) 771-5549

71 US Route 1
Ste C
Scarborough, ME 04074
Phone (207) 883-5532

3073 White Mountain Hwy
North Conway, NH 03860
Phone (603) 356-5472

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/4517c430-03bf-4e32-b324-1387cc4e73f3/
  • Direct secure messaging: amoran348197@direct.myadvocateaurora.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Mid Coast Senior Health CenterBrunswick, ME, CCN 205163 Skilled nursing facility Corporate Director
Trustee of the SNF
Feb 1, 2025
Feb 1, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669161600000",
    "number": "1255301974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 W FOREST HOME AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532152843",
            "telephone_number": "414-649-3370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 W KINNICKINNIC RIVER PKWY",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532153669",
            "telephone_number": "414-649-3370"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "71 US Route 1",
            "address_2": "SUITE C",
            "address_purpose": "LOCATION",
            "city": "Scarborough",
            "state": "ME",
            "postal_code": "040747173",
            "country_code": "US",
            "telephone_number": "207-883-5532",
            "fax_number": "207-883-5552",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MORAN",
        "first_name": "ADRIAN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-25",
        "last_updated": "2022-11-23",
        "certification_date": "2022-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "ME",
            "license": "016355",
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "ME",
            "license": "MD16355",
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "WI",
            "license": "22611",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "292420099",
            "state": "ME"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "2801 W Kinnickinnic River Pkwy",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532153669",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amoran348197@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2801 W Kinnickinnic River Pkwy",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532153669",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.