Keith J Moody D O P C

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

5101008328 Issued in MI

Legal business name

KEITH J MOODY D O P C

Practice address

200 S Wenona St
Suite 225
Bay City, MI 48706-8820

Phone

(989) 893-9705

Fax

(989) 893-8206

NPI assigned

Nov 28, 2007

Organization subpart

No

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

Authorized official

Name

Keith J Moody D O, D O

Title

Owner

Phone

(989) 893-9705

Specialties & licenses 2

Addresses

Other identifiers 9

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

{
    "created_epoch": "1196208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196208000000",
    "number": "1295917524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 S WENONA ST",
            "address_2": "SUITE 225",
            "city": "BAY CITY",
            "state": "MI",
            "postal_code": "487068820",
            "telephone_number": "989-893-9705",
            "fax_number": "989-893-8206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S WENONA ST",
            "address_2": "SUITE 225",
            "city": "BAY CITY",
            "state": "MI",
            "postal_code": "487068820",
            "telephone_number": "989-893-9705",
            "fax_number": "989-893-8206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEITH J MOODY D O P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-28",
        "last_updated": "2007-11-28",
        "status": "A",
        "authorized_official_last_name": "MOODY D O",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "989-893-9705",
        "authorized_official_credential": "D O"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5101008328",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "MI",
            "license": "5101008328",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4164290",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MI",
            "identifier": "1150900464",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCLAREN HEALTH PLAN",
            "identifier": "1006214",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEP BLUE CROSS",
            "identifier": "1150900464",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK",
            "identifier": "50900464",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIORITY HEALTH",
            "identifier": "28233",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMUNITY CHOICE",
            "identifier": "16613",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4220040",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PLUS OF MI",
            "identifier": "1150900464",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bethany Keeler Kapteyn, PHARMD
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• Marvin R Keeling, M.D.
• Dennis M Keene, MD
• Kehres Health and Chiropractic
• Robert Harold Kelch, FNP, BC
• Jodie Marie Kelly, NP-C
• Julie Kelly
• Katy Kelly
• Sara Kelly, CCC-SLP

• All providers in Bay City, MI
• Geriatric Medicine (Internal Medicine) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2007; 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.