Active NPI
Debra Moravac
- Specialist
- Independence, MO
National Provider Identifier
1265892905
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 116936
- Practice address
- 17313 E 54TH Ter CT
Independence, MO 64055-7832 - Phone
- (816) 701-6602
- NPI assigned
- Feb 23, 2016
- Last updated
- Feb 23, 2016
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Specialist | 174400000X | 116936 | MO | Primary |
Addresses
Primary practice location
17313 E 54TH Ter CT
Independence, MO 64055-7832
Mailing address
17313 E 54TH Ter CT
Independence, MO 64055-7832
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 116936 | MO | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1456185600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456185600000",
"number": "1265892905",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17313 E 54TH TER CT",
"city": "INDEPENDENCE",
"state": "MO",
"postal_code": "640557832"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17313 E 54TH TER CT",
"city": "INDEPENDENCE",
"state": "MO",
"postal_code": "640557832",
"telephone_number": "816-701-6602"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORAVAC",
"first_name": "DEBRA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-02-23",
"last_updated": "2016-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "MO",
"license": "116936",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Independence, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.