Active NPI
Virginia J Moody, MD
- Psychiatry Physician
- Normal, IL
National Provider Identifier
1255419362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 36101578
- Practice address
- 405 Kays Drive
Suite B
Normal, IL 61761 - Phone
- (309) 862-0064
- Fax
- (309) 862-1542
- NPI assigned
- Nov 2, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 36101578 | IL | Primary |
Addresses
Primary practice location
405 Kays Drive
Suite B
Normal, IL 61761
Mailing address
405 Kays Drive
Suite B
Normal, IL 61761
Phone (309) 862-0064
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 260051695 | Other | RR MEDICARE | |
| 067425 | Other | HEALTH ALLIANCE | |
| 5723204 | Other | BCBS | |
| 437668 | Other | HEALTH LINK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36101578 | IL | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gibson Community Hospital Association | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Critical Access Hospital
- Gibson City, IL
- NPI 1114935681
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405555200000",
"number": "1255419362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "405 KAYS DRIVE",
"address_2": "SUITE B",
"city": "NORMAL",
"state": "IL",
"postal_code": "61761",
"telephone_number": "309-862-0064",
"fax_number": "309-862-1542"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "405 KAYS DRIVE",
"address_2": "SUITE B",
"city": "NORMAL",
"state": "IL",
"postal_code": "61761",
"telephone_number": "309-862-0064",
"fax_number": "309-862-1542"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOODY",
"first_name": "VIRGINIA",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-02",
"last_updated": "2014-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "IL",
"license": "36101578",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "260051695",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ALLIANCE",
"identifier": "067425",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "5723204",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH LINK",
"identifier": "437668",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Normal, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.