Active NPI
Edwin O Moranga, REGISTERED NURSE
- Registered Nurse
- Savage, MN
National Provider Identifier
1407519630
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 2206640
- Practice address
- 12707 Inglewood Ave S
Savage, MN 55378-1576 - Phone
- (616) 856-0163
- NPI assigned
- Oct 14, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 2206640 | MN | Primary |
Addresses
Primary practice location
12707 Inglewood Ave S
Savage, MN 55378-1576
Mailing address
12707 Inglewood Ave S
Savage, MN 55378-1576
Phone (616) 856-0163
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 933217 | Medicaid | MN |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | 12707InglewoodAveSSavage55378 | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2206640 | MN | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Imara LLC | Current | Accepting new patients | |
| Nuru Home Healthcare LLC | Multi-Specialty | Current | Accepting new patients |
Organizations & group practices 2
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.
-
- Foster Care Agency
- Wyoming, MI
- NPI 1609759075
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1634169600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634169600000",
"number": "1407519630",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12707 INGLEWOOD AVE S",
"city": "SAVAGE",
"state": "MN",
"postal_code": "553781576",
"telephone_number": "616-856-0163"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12707 INGLEWOOD AVE S",
"city": "SAVAGE",
"state": "MN",
"postal_code": "553781576",
"telephone_number": "616-856-0163"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORANGA",
"first_name": "EDWIN",
"middle_name": "O",
"credential": "REGISTERED NURSE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-10-14",
"last_updated": "2021-10-14",
"certification_date": "2021-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Registered Nurse",
"state": "MN",
"license": "2206640",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "933217",
"state": "MN"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "12707InglewoodAveSSavage55378",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "12707 Inglewood Ave S",
"city": "Savage",
"state": "MN",
"country_code": "US",
"postal_code": "553781576",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Savage, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.