NPIMap

Individual provider Active NPI

Marie Elise Moulton, MD

  • Internal Medicine Physician
  • Bend, OR
National Provider Identifier
1568969574
Registry record updated Sep 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
11405445-1205 Issued in UT
Practice address
2500 NE Neff Rd
Bend, OR 97701-6015
Phone
(754) 706-6892
Fax
(541) 706-6813
NPI assigned
Apr 7, 2018
Last updated
Sep 2, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 11405445-1205 UT Primary

Addresses

Primary practice location

2500 NE Neff Rd
Bend, OR 97701-6015

Mailing address

30 N 1900 E RM 4C116
Salt Lake City, UT 84132-0002
Phone (801) 581-7606

Other practice location 1

50 N Medical Dr
Salt Lake City, UT 84132-0001
Phone (801) 581-2121

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mmoulton159137@secure.stcharleshealthcare.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220831002112 OR Practitioner - Internal Medicine 7214360163 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
East Tennessee State University Quillen College of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Charles Health System IncGroup PAC ID 3870402852, 174 clinicians

Practice addresses (Care Compare)

2500 NE Neff Rd
Bend, OR 97701-6015
Phone (541) 706-2768

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St. Charles Health System, Inc. CurrentSince Aug 29, 2022 Accepting new patients
St. Charles Health System, Inc. Internal Medicine CurrentSince Aug 29, 2022 Accepting new patients
St. Charles Health System, Inc. Internal Medicine Current Accepting new patients
St. Charles Health System, Inc. Past Accepting new patients
St. Charles Health System, Inc. Past Accepting new patients

Locations

29358 Network Pl
Chicago, IL 60673

2500 NE Neff Rd
Bend, OR 97701
Phone (541) 388-4333

1253 NW Canal Blvd
Redmond, OR 97756
Phone (541) 548-8131

Organizations & group practices 5

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 7

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": "1523059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662076800000",
    "number": "1568969574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 N 1900 E RM 4C116",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841320002",
            "telephone_number": "801-581-7606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 NE NEFF RD",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016015",
            "telephone_number": "754-706-6892",
            "fax_number": "541-706-6813"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "50 N Medical Dr",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841320001",
            "country_code": "US",
            "telephone_number": "801-581-2121",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOULTON",
        "first_name": "MARIE",
        "middle_name": "ELISE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-07",
        "last_updated": "2022-09-02",
        "certification_date": "2022-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "UT",
            "license": "11405445-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmoulton159137@secure.stcharleshealthcare.org",
            "affiliation": "N",
            "address_1": "2500 NE Neff Rd",
            "city": "Bend",
            "state": "OR",
            "country_code": "US",
            "postal_code": "977016015",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

Verify at the official NPI Registry.