NPIMap

Organization Active NPI

Lotus Moon, LLC

  • In Home Supportive Care Agency
  • Minnetonka, MN
National Provider Identifier
1295339166
Registry record updated Nov 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
Legal business name
LOTUS MOON, LLC
Practice address
14667 Lake Street Ext
Minnetonka, MN 55345-2926
Phone
(612) 584-0917
NPI assigned
Nov 22, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2020

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

Authorized official

Name
Pesey M KuochNPI 1487279030
Title
Owner
Phone
(612) 535-7292

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Meals Provider 174200000X
Lodging Provider 177F00000X
Nursing Care Agency 251J00000X
In Home Supportive Care Agency 253Z00000X Primary

Addresses

Primary practice location

14667 Lake Street Ext
Minnetonka, MN 55345-2926

Mailing address

15401 Lake Street Ext
Minnetonka, MN 55345-1914
Phone (612) 535-7292

Other names 1

  • Lotus Moon Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Lotussmoon@outlook.com Direct

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1606003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606003200000",
    "number": "1295339166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15401 LAKE STREET EXT",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553451914",
            "telephone_number": "612-535-7292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14667 LAKE STREET EXT",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553452926",
            "telephone_number": "612-584-0917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOTUS MOON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-22",
        "last_updated": "2020-11-22",
        "certification_date": "2020-11-22",
        "status": "A",
        "authorized_official_last_name": "KUOCH",
        "authorized_official_first_name": "PESEY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-535-7292"
    },
    "taxonomies": [
        {
            "code": "174200000X",
            "taxonomy_group": "",
            "desc": "Meals",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "177F00000X",
            "taxonomy_group": "",
            "desc": "Lodging",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Lotussmoon@outlook.com",
            "affiliation": "N",
            "endpointDescription": "Lotussmoon@outlook.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "14667 Lake Street Ext",
            "city": "Minnetonka",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553452926",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Lotus Moon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Minnetonka, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.