Melissa Mae Moutray, MD DDS

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

04-41292 Issued in KS

Practice address

311 Campus Drive
Suite 101
Garden City, KS 67846

Phone

(602) 272-0100

Fax

(620) 271-0160

NPI assigned

May 25, 2010

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jun 17, 2016 through Jun 17, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Southwest Oral & Maxillofacial Surgery LLC

  • Oral and Maxillofacial Surgery Clinic/Center
  • Garden City, KS
  • NPI 1548432628
  NPD (past)
• David J Rallis DDS MD Oral and Maxillofacial Surgery, PC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Lincoln, NE
  • NPI 1760708218
  NPD (past)
• River Ridge Oral & Maxillofacial Surgical Center

  • Oral and Maxillofacial Surgery (Dentist)
  • Sioux Falls, SD
  • NPI 1376522714
  NPD (past)

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

{
    "created_epoch": "1274745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626307200000",
    "number": "1386963718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 CAMPUS DRIVE",
            "address_2": "SUITE 101",
            "city": "GARDEN CITY",
            "state": "KS",
            "postal_code": "67846",
            "telephone_number": "602-272-0100",
            "fax_number": "620-271-0160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 CAMPUS DRIVE",
            "address_2": "SUITE 101",
            "city": "GARDEN CITY",
            "state": "KS",
            "postal_code": "67846",
            "telephone_number": "602-272-0100",
            "fax_number": "620-271-0160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUTRAY",
        "first_name": "MELISSA",
        "middle_name": "MAE",
        "credential": "MD DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-25",
        "last_updated": "2021-07-15",
        "certification_date": "2021-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "SD",
            "license": "D1107",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "KS",
            "license": "04-41292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adilene Morales Ballesteros
• Sasha Morales Ramirez, APRN, FNP-BC
• Mosaic
• Peter A Motley, LSCSW 0543
• Mountain States Pathology PC
• Jessica Ann Mueller, MS, RD, LMNT, LD
• Tammy D Murillo, LSCSW
• Wendy B Murray, LMSW
• Margaret F Myers, LSCSW
• Troy K Nanninga, LPC

• Oral & Maxillofacial Surgery (D.M.D.) in Garden City, KS
• Providers in Garden City, KS by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2021; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.