Individual provider Active NPI

Michael J Moller, PSYD

Clinical Psychologist
Hudson, WI

National Provider Identifier

1578647004

Registry record updated Sep 28, 2010

On this page

Key facts
NPPES NPI Registry
Medicare participation
Care Compare profile
National Provider Directory
Organizations & group practices1
NPI Registry JSON
Other providers in Hudson, WI
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Clinical PsychologistTaxonomy code 103TC0700X
License: 2320 Issued in WI
Practice address: 900 6TH St N
102
Hudson, WI 54016-7171
Phone: (715) 386-0856
Fax: (715) 386-0948
NPI assigned: Oct 24, 2006
Last updated: Sep 28, 2010By the provider in NPPES
Sex: Male
Sole proprietor: Yes

NPPES NPI Registry

Updated by the provider on Sep 28, 2010

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

Specialties & licenses 5

Specialty (taxonomy)	Code	License	State	Primary
Psychologist	103T00000X	2320	WI
Clinical Psychologist	103TC0700X	2320	WI	Primary
Clinical Child & Adolescent Psychologist	103TC2200X	2320	WI
Family Psychologist	103TF0000X	2320	WI
Forensic Psychologist	103TF0200X	2320	WI

Addresses

Primary practice location

900 6TH St N
102
Hudson, WI 54016-7171

Mailing address

900 6TH St N
102
Hudson, WI 54016-7171
Phone (715) 386-0856

Other identifiers 18

Identifier	Type	State	Issuer
20558-03	Other		BEHAVIOR HEALTH PROVIDERS
NA9031027526	Other	MN	PREFERRED ONE
2172193	Other	WI	COMPSYCH
880824400	Medicaid	MN
SSN	Other		HEALTHNET / TRICARE
1202109 16675	Other		MAGELLEN
01413	Other	WI	GROUP HEALTH
SSN001	Other	WI	ANTHEM BLUE CROSS OF WI
01413	Other		COMPCARE
39739300	Medicaid	WI
431R2MO	Other	MN	BCBS
39739300	Other	WI	WISCONSIN MEDICAL ASSISTANCE
439K4MO	Other	MN	BCBS
115830	Other		UCARE
HP20346	Other	MN	HEALTHPARTNERS
036J4MO	Other	MN	BCBS MN PRO FEE
61-74465	Other	MN	MEDICA / UBH
61-74465	Other	WI	UBH

Medicare participation

Medicare enrollment files

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

Part B services: Yes
Medical equipment: Yes
Home health: No
Power mobility devices: No
Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Enrollment ID	State	Provider type	PAC ID	Details
I20070416000492	WI	Practitioner - Clinical Psychologist	2163527490	Practice locations: Hudson, WI

Care Compare profile

Medicare Care Compare

Specialty: Clinical Psychologist
Education: Other, 1998
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Telehealth: Offers telehealth services

Practice addresses (Care Compare)

900 6TH St N
Hudson, WI 54016-7172
Phone (715) 386-0856

National Provider Directory

Medicare enrollment (NPD): Enrolled

State licenses

License	State	Type	Specialty
2320	WI	MD	General Practice Dentistry

Practice roles

Organization	Specialty	Status	New patients
Michael J Moller PA	Psychologist	Past	Accepting new patients

Organizations & group practices 1

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.

Michael J Moller PA
- Psychologist
- Hudson, WI
- NPI 1992000657
NPD (past) Authorized official

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285632000000",
    "number": "1578647004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 6TH ST N",
            "address_2": "102",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540167171",
            "telephone_number": "715-386-0856",
            "fax_number": "715-386-0948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 6TH ST N",
            "address_2": "102",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540167171",
            "telephone_number": "715-386-0856",
            "fax_number": "715-386-0948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOLLER",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2010-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "2320",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "2320",
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "WI",
            "license": "2320",
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "WI",
            "license": "2320",
            "primary": false
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "WI",
            "license": "2320",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEHAVIOR HEALTH PROVIDERS",
            "identifier": "20558-03",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "NA9031027526",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMPSYCH",
            "identifier": "2172193",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "880824400",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET / TRICARE",
            "identifier": "SSN",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLEN",
            "identifier": "1202109 16675",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH",
            "identifier": "01413",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS OF WI",
            "identifier": "SSN001",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMPCARE",
            "identifier": "01413",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39739300",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "431R2MO",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WISCONSIN MEDICAL ASSISTANCE",
            "identifier": "39739300",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "439K4MO",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "115830",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "HP20346",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MN PRO FEE",
            "identifier": "036J4MO",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA / UBH",
            "identifier": "61-74465",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UBH",
            "identifier": "61-74465",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hudson, WI

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.