Individual provider Active NPI

Patrick Nakashima-Moran, D.O.

  • Family Medicine Physician
  • O'Fallon, IL
National Provider Identifier
1558743138
Registry record updated Jan 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036.145202 Issued in IL
Practice address
732 Sussex Way
O Fallon, IL 62269-3074
Phone
(618) 607-8110
NPI assigned
Jun 19, 2015
Last updated
Jan 16, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036.145202 IL Primary

Addresses

Primary practice location

732 Sussex Way
O Fallon, IL 62269-3074

Mailing address

9215 Laurel Hill Dr
Saint Louis, MO 63126-2819
Phone (636) 579-9702

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20180731001899 IL Practitioner - Family Practice 1153628078 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Kansas City University of Physicians and Surgeons, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
English and McLaughlin, PCGroup PAC ID 7618350448, 10 clinicians

Practice addresses (Care Compare)

1167 Fortune Blvd
Shiloh, IL 62269-7377
Phone (618) 207-6900

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.145202ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
English and McLaughlin, P.C. Family Medicine CurrentSince Aug 1, 2022 Accepting new patients
Washington University Past Accepting new patients
Chiromed LTD PastSince Aug 1, 2018 Accepting new patients

Locations

1167 Fortune Blvd
Shiloh, IL 62269
Phone (618) 207-6900

Interoperability endpoints

  • Direct secure messaging: patrick.nakashimamoran.p2@direct.essehealth.nextgenshare.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Ardent Hospice & Palliative Care Southern Illinois, Inc.O Fallon, IL, CCN 141734 Hospice Contracted Managing Employee (2%)
Corporate Officer (2%)
Dec 19, 2023
Dec 19, 2023

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1434672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768521600000",
    "number": "1558743138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9215 LAUREL HILL DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631262819",
            "telephone_number": "636-579-9702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "732 SUSSEX WAY",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622693074",
            "telephone_number": "618-607-8110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAKASHIMA-MORAN",
        "first_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-19",
        "last_updated": "2026-01-16",
        "certification_date": "2026-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.145202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in O'Fallon, IL

Sources for this page

Verify at the official NPI Registry.