Jaden Rene Moomaw

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209027942 Issued in IL

Practice address

2512 Hurst Dr Ste 120
Mattoon, IL 61938-9200

Phone

(217) 258-7590

Fax

(217) 258-3686

NPI assigned

Feb 12, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Hoopeston Community Memorial HospitalGroup PAC ID 3577456037, 142 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Carle Hoopeston Regional Health Center Hospital, Hoopeston, IL, CCN 141316
• Carle Foundation Hospital Hospital, Urbana, IL, CCN 140091
• Sarah Bush Lincoln Health Center Hospital, Mattoon, IL, CCN 140189

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jmoomawaprn384892@carlehiedirect.net

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.

• Carle Health Care Incorporated

  dba Carle Physician Group

  • Internal Medicine Physician
  • Urbana, IL
  • NPI 1154653947
  Medicare reassignment Care Compare group NPD
• Hoopeston Community Memorial Hospital

  dba Hoopeston Physician Group

  • Internal Medicine Physician
  • Hoopeston, IL
  • NPI 1043683014
  Medicare reassignment Care Compare group NPD
• Hoopeston Community Memorial Hospital

  • Critical Access Hospital
  • Hoopeston, IL
  • NPI 1366480873
  NPD
• Hoopeston Community Memorial Hospital

  dba Charlotte Ann Russell Medical Center

  • Rural Health Clinic/Center
  • Hoopeston, IL
  • NPI 1578504544
  NPD
• Carle Health Care Incorporated

  • Durable Medical Equipment & Medical Supplies
  • Champaign, IL
  • NPI 1114240876
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Carle Surgicenter

  • Ambulatory Surgical Clinic/Center
  • Danville, IL
  • NPI 1225194533

  Hospital

  Care Compare affiliation
• Hoopeston Community Memorial Hospital

  dba Hoopeston Community Ambulance

  • Ambulance
  • Hoopeston, IL
  • NPI 1164594594

  Hospital

  Care Compare affiliation
• Hoopeston Community Memorial Hospital

  • Critical Access Hospital
  • Hoopeston, IL
  • NPI 1366480873
  Care Compare affiliation
• Sarah Bush Lincoln Health Center

  • General Acute Care Hospital
  • Mattoon, IL
  • NPI 1669564662
  Care Compare affiliation
• The Carle Foundation Hospital

  • General Acute Care Hospital
  • Urbana, IL
  • NPI 1013071653
  Care Compare affiliation

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

{
    "created_epoch": "1644624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709164800000",
    "number": "1376298919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2512 HURST DR STE 120",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619389200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2512 HURST DR STE 120",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619389200",
            "telephone_number": "217-258-7590",
            "fax_number": "217-258-3686"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6 Hairpin Dr",
            "address_purpose": "LOCATION",
            "city": "Edwardsville",
            "state": "IL",
            "postal_code": "620261000",
            "country_code": "US",
            "telephone_number": "618-650-3956",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOOMAW",
        "first_name": "JADEN",
        "middle_name": "RENE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-12",
        "last_updated": "2024-02-29",
        "certification_date": "2024-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209027942",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ragai Mitry, M.D.
• Esaie Momgbet
• Tiffany Ellen Monroe
• Earline Cynthel Montgomery
• Tucker Evan Moody, RSA
• Adam Joseph Moon
• Laurie E Mooney, APN
• Heather Moore Hinton
• Danielle Morr, APRN
• Julia Morris

• Family Nurse Practitioner in Mattoon, IL
• Providers in Mattoon, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.