Individual provider Active NPI

Carly Lynn Moe, LCSW

  • Clinical Social Worker
  • Eugene, OR
National Provider Identifier
1457428484
Registry record updated Jul 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L5867 Issued in OR
Practice address
1200 Hilyard St
Suite 540
Eugene, OR 97401-8122
Phone
(458) 205-7101
NPI assigned
Nov 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X L5867 OR Primary

Addresses

Primary practice location

1200 Hilyard St
Suite 540
Eugene, OR 97401-8122

Mailing address

1200 Hilyard St
Suite 540
Eugene, OR 97401-8122

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150617003186 OR Practitioner - Clinical Social Worker 1658682695 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Peacehealth Medical GroupGroup PAC ID 9032023270, 256 clinicians

Practice addresses (Care Compare)

4010 Aerial Way
Eugene, OR 97402-9757
Phone (613) 272-4978

770 E 11 Ave
Eugene, OR 97401-3746
Phone (458) 205-7100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
L5867ORMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Peacehealth Medical Group CurrentSince Mar 30, 2015 Accepting new patients
Peacehealth Medical Group Clinical CurrentSince Mar 30, 2015 Accepting new patients

Locations

4010 Aerial Way
Eugene, OR 97402
Phone (541) 242-8300

1200 Hilyard St
Ste 540
Eugene, OR 97401
Phone (458) 205-7070

1115 SE 164th Ave
Dept 358
Vancouver, WA 98683
Phone (360) 729-1253

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.

NPI Registry JSON

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404259200000",
    "number": "1457428484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 HILYARD ST",
            "address_2": "SUITE 540",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974018122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 HILYARD ST",
            "address_2": "SUITE 540",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974018122",
            "telephone_number": "458-205-7101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOE",
        "first_name": "CARLY",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-28",
        "last_updated": "2014-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L5867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eugene, OR

Sources for this page

Verify at the official NPI Registry.