Individual provider Active NPI

John Kenneth Mori, M.D.

  • Sleep Medicine (Psychiatry & Neurology) Physician
  • Boulder, CO
National Provider Identifier
1497767172
Registry record updated Jul 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sleep Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084S0012X
License
42465 Issued in TN
Practice address
4895 Riverbend Rd
Suite a
Boulder, CO 80301-2640
Phone
(720) 279-9098
Fax
(720) 540-4250
NPI assigned
Aug 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sleep Medicine (Psychiatry & Neurology) Physician 2084S0012X 42465 TN Primary

Addresses

Primary practice location

4895 Riverbend Rd
Suite a
Boulder, CO 80301-2640

Mailing address

3712 Woodmont LN Unit B
Nashville, TN 37215-1714
Phone (615) 509-0584

Other identifiers 2

IdentifierTypeStateIssuer
K167432OtherKYMEDICARE
7100048410MedicaidKY

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)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Sleep Centers of Middle Tennessee LLC Sleep Medicine PastSince Jul 6, 2004 Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CEBDAA

Organizations & group practices 1

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": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721779200000",
    "number": "1497767172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3712 WOODMONT LN UNIT B",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372151714",
            "telephone_number": "615-509-0584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4895 RIVERBEND RD",
            "address_2": "SUITE A",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803012640",
            "telephone_number": "720-279-9098",
            "fax_number": "720-540-4250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORI",
        "first_name": "JOHN",
        "middle_name": "KENNETH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-12",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084S0012X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Sleep Medicine",
            "state": "TN",
            "license": "42465",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "K167432",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100048410",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2024; 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.