Individual provider Active NPI

Robert Shannon Moran, M.D.

  • Pediatrics Physician
  • Murfreesboro, TN
National Provider Identifier
1558604132
Registry record updated Jun 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD54273 Issued in TN
Practice address
1272 Garrison Dr
Murfreesboro, TN 37129-2598
Phone
(615) 893-4480
Fax
(615) 895-6212
NPI assigned
Apr 1, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD54273 TN Primary

Addresses

Primary practice location

1272 Garrison Dr
Murfreesboro, TN 37129-2598

Mailing address

1272 Garrison Dr
Murfreesboro, TN 37129-2598
Phone (615) 893-4480

Other practice location 1

4301 W Markham St
Little Rock, AR 72205-7101
Phone (501) 686-5356

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170911001282 TN Practitioner - Pediatric Medicine 9537488192 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Murfreesboro Medical Clinic, P.a. Current Accepting new patients

Locations

1272 Garrison Dr
Ste 303
Murfreesboro, TN 37129
Phone (615) 849-9358

1272 Garrison Dr
Murfreesboro, TN 37129
Phone (615) 867-7925

Interoperability endpoints

  • Direct secure messaging: robertmoran@mmcsc.allscriptsdirect.net

Organizations & group practices 2

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": "1364774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593129600000",
    "number": "1558604132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1272 GARRISON DR",
            "city": "MURFREESBORO",
            "state": "TN",
            "postal_code": "371292598",
            "telephone_number": "615-893-4480",
            "fax_number": "615-895-6212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1272 GARRISON DR",
            "city": "MURFREESBORO",
            "state": "TN",
            "postal_code": "371292598",
            "telephone_number": "615-893-4480",
            "fax_number": "615-895-6212"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4301 W Markham St",
            "address_purpose": "LOCATION",
            "city": "Little Rock",
            "state": "AR",
            "postal_code": "722057101",
            "country_code": "US",
            "telephone_number": "501-686-5356",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MORAN",
        "first_name": "ROBERT",
        "middle_name": "SHANNON",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-01",
        "last_updated": "2020-06-26",
        "certification_date": "2020-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "MD54273",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Murfreesboro, TN

Sources for this page

Verify at the official NPI Registry.