Individual provider Active NPI

John E Moran, M.D.

  • Family Medicine Physician
  • Evansville, IN
National Provider Identifier
1265401434
Registry record updated Jul 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01029646A Issued in IN
Practice address
4506 1St Ave
Evansville, IN 47710-3324
Phone
(812) 428-6161
Fax
(812) 421-2883
NPI assigned
Mar 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 01029646A IN Primary

Addresses

Primary practice location

4506 1St Ave
Evansville, IN 47710-3324

Mailing address

PO Box 1510
Evansville, IN 47706-1510
Phone (812) 428-6161

Other identifiers 1

IdentifierTypeStateIssuer
100151700MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01029646AINMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Deaconess Clinic Inc. Current Accepting new patients
Deaconess Clinic Inc. Family Medicine CurrentSince Jul 1, 2012 Accepting new patients
Deaconess Clinic Inc Family Medicine CurrentSince Jul 1, 2012 Accepting new patients

Locations

4506 N 1st Ave
Evansville, IN 47710
Phone (812) 428-6161

421 Chestnut St
Evansville, IN 47713
Phone (812) 426-6645

3844 N 1st Ave
Evansville, IN 47710
Phone (812) 421-2884

1204 Williams St
Oakland City, IN 47660
Phone (812) 749-6187

1414 W Broadway St
Princeton, IN 47670
Phone (812) 385-5283

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.

NPI Registry JSON

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

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374624000000",
    "number": "1265401434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1510",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477061510",
            "telephone_number": "812-428-6161",
            "fax_number": "812-421-2883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4506 1ST AVE",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477103324",
            "telephone_number": "812-428-6161",
            "fax_number": "812-421-2883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORAN",
        "first_name": "JOHN",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-17",
        "last_updated": "2013-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01029646A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100151700",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

Verify at the official NPI Registry.