NPIMap

Individual provider Active NPI

Hernando Moreno, MD

  • Internal Medicine Physician
  • Valdosta, GA
National Provider Identifier
1396950994
Registry record updated Oct 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
059473 Issued in GA
Practice address
3207 Country Club Dr
Valdosta, GA 31605-1029
Phone
(229) 242-8480
Fax
(229) 241-0252
NPI assigned
May 14, 2007
Last updated
Oct 16, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 059473 GA Primary

Addresses

Primary practice location

3207 Country Club Dr
Valdosta, GA 31605-1029

Mailing address

3207 Country Club Dr
Valdosta, GA 31605-1029
Phone (229) 242-8480

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070702000498 GA Practitioner - Internal MedicinePractitioner - Dermatology 0840390944 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians
SGMC Physician Network IncGroup PAC ID 4082036843, 128 clinicians

Practice addresses (Care Compare)

2600 Compass Rd
Glenview, IL 60026-8001

3207 Country Club Rd
Valdosta, GA 31605-1029
Phone (229) 242-8480

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
059473GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group of Georgia LLC Internal Medicine CurrentSince May 19, 2017 Accepting new patients
SGMC Affiliated Services LLC Current Accepting new patients
Privia Medical Group of Georgia LLC Internal Medicine CurrentSince May 19, 2017 Accepting new patients
SGMC Physician Network Inc CurrentSince Nov 1, 2020 Accepting new patients
Valdosta Medical Clinic CurrentSince Jul 1, 2007 Accepting new patients
Apogee Medical Group Georgia Inc Internal Medicine CurrentSince Jan 10, 2017 Accepting new patients

Locations

15059 N Scottsdale Rd
Ste 600
Scottsdale, AZ 85254
Phone (602) 778-3601

101 Yorktown Dr
Ste 100
Fayetteville, GA 30214
Phone (770) 460-4285

915 Gordon Ave
Thomasville, GA 31792
Phone (229) 228-8575

2501 N Patterson St
Valdosta, GA 31602
Phone (229) 259-4139

3207 Country Club Rd
Valdosta, GA 31605
Phone (229) 242-8480

4280 N Valdosta Rd
Valdosta, GA 31602
Phone (229) 433-7350

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224115200000",
    "number": "1396950994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3207 COUNTRY CLUB DR",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316051029",
            "telephone_number": "229-242-8480",
            "fax_number": "229-241-0252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3207 COUNTRY CLUB DR",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316051029",
            "telephone_number": "229-242-8480",
            "fax_number": "229-241-0252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORENO",
        "first_name": "HERNANDO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-14",
        "last_updated": "2008-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "059473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valdosta, GA

Sources for this page

Verify at the official NPI Registry.