Active NPI
Jeremy David Moll, M.D.
- Pediatrics Physician
- Scott Afb, IL
National Provider Identifier
1538282942
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 01063842A
- Practice address
- 310 W Losey St
Scott Afb, IL 62225-5250 - Phone
- (618) 256-7827
- NPI assigned
- Apr 9, 2007
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 01063842A | IN | Primary |
Addresses
Primary practice location
310 W Losey St
Scott Afb, IL 62225-5250
Mailing address
4979 Odell St
Saint Louis, MO 63139-1009
Phone (314) 330-1866
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01063842A | IN | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1744848000000",
"number": "1538282942",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4979 ODELL ST",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631391009",
"telephone_number": "314-330-1866"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "310 W LOSEY ST",
"city": "SCOTT AFB",
"state": "IL",
"postal_code": "622255250",
"telephone_number": "618-256-7827"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOLL",
"first_name": "JEREMY",
"middle_name": "DAVID",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-09",
"last_updated": "2025-04-17",
"certification_date": "2025-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IN",
"license": "01063842A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Scott Afb, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.