Individual provider Active NPI

Clint P Moses, DC

  • Chiropractor
  • Menomonie, WI
National Provider Identifier
1528095601
Registry record updated Jul 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3995-012 Issued in WI
Practice address
2321 Hwy 25 N.
#6
Menomonie, WI 54751
Phone
(715) 231-4994
Fax
(715) 231-2099
NPI assigned
Jun 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3995-012 WI Primary

Addresses

Primary practice location

2321 Hwy 25 N.
#6
Menomonie, WI 54751

Mailing address

2321 Hwy 25 N.
#6
Menomonie, WI 54751
Phone (715) 231-4994

Other identifiers 1

IdentifierTypeStateIssuer
38972800MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040405001015 WI Practitioner - Chiropractic 0547252009 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Red Cedar Chiropractic LLCGroup PAC ID 9032101597, 2 clinicians

Practice addresses (Care Compare)

1415 Broadway St N
Menomonie, WI 54751-4707
Phone (715) 231-4994

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3995-012WIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Red Cedar Chiropractic, LLC Chiropractor CurrentSince Dec 20, 2003 Accepting new patients

Locations

2321 State Highway 25 N
#6
Menomonie, WI 54751
Phone (715) 231-4994

1415 Broadway St N
Menomonie, WI 54751
Phone (715) 231-4994

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": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215993600000",
    "number": "1528095601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2321 HWY 25 N.",
            "address_2": "#6",
            "city": "MENOMONIE",
            "state": "WI",
            "postal_code": "54751",
            "telephone_number": "715-231-4994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2321 HWY 25 N.",
            "address_2": "#6",
            "city": "MENOMONIE",
            "state": "WI",
            "postal_code": "54751",
            "telephone_number": "715-231-4994",
            "fax_number": "715-231-2099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSES",
        "first_name": "CLINT",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-26",
        "last_updated": "2008-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3995-012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38972800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Menomonie, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.