Active NPI
Moises A Menendez, MD
- Surgery Physician
- Magnolia, AR
National Provider Identifier
1508851320
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- R2525
- Practice address
- 101 Hosptial Drive
Magnolia, AR 71753 - Phone
- (870) 235-3600
- NPI assigned
- Sep 19, 2005
- Last updated
- Jun 18, 2010
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | R2525 | AR | Primary |
Addresses
Primary practice location
101 Hosptial Drive
Magnolia, AR 71753
Mailing address
PO Box 629
Magnolia, AR 71754
Phone (870) 235-3600
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 106120001 | Medicaid | AR | |
| 53626 | Other | AR | BLUE CROSS |
| 195228501 | Medicaid | TX | |
| 8AL616 | Other | TX | BCBS |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R2525 | AR | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1276819200000",
"number": "1508851320",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 629",
"city": "MAGNOLIA",
"state": "AR",
"postal_code": "71754",
"telephone_number": "870-235-3600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 HOSPTIAL DRIVE",
"city": "MAGNOLIA",
"state": "AR",
"postal_code": "71753",
"telephone_number": "870-235-3600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENENDEZ",
"first_name": "MOISES",
"middle_name": "A",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-19",
"last_updated": "2010-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "AR",
"license": "R2525",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "106120001",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "53626",
"state": "AR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "195228501",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "8AL616",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Magnolia, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 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.