Edward Sidney Moak, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

09304 Issued in MS

Practice address

1167 E Broad St
Monticello, MS 39654-7682

Phone

(601) 587-1433

Fax

(601) 587-1625

NPI assigned

Aug 24, 2006

Last updated

Jun 30, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: edward.moak.1@13136.direct.athenahealth.com

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.

• Joseph S Moak Jr MD PA

  • Internal Medicine Physician
  • Brookhaven, MS
  • NPI 1043639289
  NPD (past)

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688083200000",
    "number": "1437266384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 490",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396490490",
            "telephone_number": "601-250-4366",
            "fax_number": "601-250-4367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1167 E BROAD ST",
            "city": "MONTICELLO",
            "state": "MS",
            "postal_code": "396547682",
            "telephone_number": "601-587-1433",
            "fax_number": "601-587-1625"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "827 F E Sellers Hwy",
            "address_purpose": "LOCATION",
            "city": "Monticello",
            "state": "MS",
            "postal_code": "396549378",
            "country_code": "US",
            "telephone_number": "601-587-4648",
            "fax_number": "601-587-0613",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOAK",
        "first_name": "EDWARD",
        "middle_name": "SIDNEY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-24",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "09304",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN BLUE CROSS",
            "identifier": "MS09304",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "060039545",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00010333",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael C Campbell
• Midsouth Happy Living LLC (Tiffany Haley)
• Jacentha Latress Miller, FNP
• Mississippi Em-I Medical Serives PC
• Mississippi State Department of Health
• Monticello Community Care Center LLC (Lawrence County Nursing Center)
• Jacqueline Moore, FNP-C
• Bonita C Musial, M.D.
• Katie R Neal
• Susan Nevels, RPH

• Internal Medicine Physician in Monticello, MS
• Providers in Monticello, MS by specialty
• Internal Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2023; 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.