Individual provider Active NPI

Colin Lee Moffett, D.P.M.

  • Primary Podiatric Medicine Podiatrist
  • Gastonia, NC
National Provider Identifier
1568411007
Registry record updated May 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Podiatric Medicine PodiatristTaxonomy code 213EP1101X
License
139 Issued in NC
Practice address
111 E 3Rd Ave
Gastonia, NC 28052-4317
Phone
(704) 874-3300
NPI assigned
May 10, 2006
Last updated
May 3, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 3, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Podiatric Medicine Podiatrist 213EP1101X 139 NC Primary
Foot Surgery Podiatrist 213ES0131X 139 NC

Addresses

Primary practice location

111 E 3Rd Ave
Gastonia, NC 28052-4317

Mailing address

200 E 2ND Ave
Gastonia, NC 28052-4358
Phone (704) 874-1900

Other practice location 1

143 N 3rd St
Albemarle, NC 28001-4901
Phone (704) 983-5763

Other identifiers 3

IdentifierTypeStateIssuer
8908125MedicaidNC
56-1384996OtherNCTAX ID
08125OtherNCBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051229000566 NC Practitioner - Podiatry 4486676723 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
California School of Podiatric Medicine, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

420 N Salisbury St
Lexington, NC 27292-3548
Phone (336) 249-6215

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
139NCMDPrimary Podiatric Medicine Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Uwharrie Podiatry, LLC Current Accepting new patients
Gaston Family Health Services, Inc. CurrentSince May 14, 2024 Accepting new patients
Gaston Family Health Services, Inc CurrentSince May 14, 2024 Accepting new patients
Dpmmoffettnrnc LLC Podiatrist PastSince Aug 16, 2005 Accepting new patients

Locations

143 N 3rd St
Albemarle, NC 28001
Phone (704) 786-4482

111 E 3rd Ave
Gastonia, NC 28052
Phone (704) 853-5079

200 E 2nd Ave
Gastonia, NC 28052
Phone (704) 874-1904

991 W Hudson Blvd
Gastonia, NC 28052
Phone (704) 853-5000

Interoperability endpoints

  • Direct secure messaging: cmoffett655843@direct.ochin.org

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714694400000",
    "number": "1568411007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E 2ND AVE",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280524358",
            "telephone_number": "704-874-1900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E 3RD AVE",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280524317",
            "telephone_number": "704-874-3300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "143 N 3rd St",
            "address_purpose": "LOCATION",
            "city": "Albemarle",
            "state": "NC",
            "postal_code": "280014901",
            "country_code": "US",
            "telephone_number": "704-983-5763",
            "fax_number": "704-983-5642",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOFFETT",
        "first_name": "COLIN",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-10",
        "last_updated": "2024-05-03",
        "certification_date": "2024-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "NC",
            "license": "139",
            "primary": true
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "NC",
            "license": "139",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8908125",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "56-1384996",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "08125",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gastonia, NC

Sources for this page

Verify at the official NPI Registry.