Active NPI
James Brian Moeller, MT
- Medical Technologist
- Sisseton, SD
National Provider Identifier
1497070080
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Technologist
- License
- 189324
- Practice address
- 100 Lake Traverse Drive
Sisseton, SD 57262 - Phone
- (605) 742-3792
- NPI assigned
- Apr 7, 2010
- Last updated
- Apr 7, 2010
- 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 |
|---|---|---|---|---|
| Medical Technologist | 246QM0706X | 189324 | SD | Primary |
Addresses
Primary practice location
100 Lake Traverse Drive
Sisseton, SD 57262
Mailing address
100 Lake Traverse Drive
Sisseton, SD 57262
Phone (605) 742-3792
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
- Credentials
- Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 189324 | SD | MD | Medical Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1270598400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1270598400000",
"number": "1497070080",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 LAKE TRAVERSE DRIVE",
"city": "SISSETON",
"state": "SD",
"postal_code": "57262",
"telephone_number": "605-742-3792"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 LAKE TRAVERSE DRIVE",
"city": "SISSETON",
"state": "SD",
"postal_code": "57262",
"telephone_number": "605-742-3792"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOELLER",
"first_name": "JAMES",
"middle_name": "BRIAN",
"credential": "MT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-04-07",
"last_updated": "2010-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "246QM0706X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Pathology, Medical Technologist",
"state": "SD",
"license": "189324",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sisseton, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.