NPIMap

Individual provider Active NPI

Despina Moise, MD

  • Child & Adolescent Psychiatry Physician
  • Logansport, IN
National Provider Identifier
1588968556
Registry record updated Jan 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
01067082A Issued in IN
Practice address
1015 Michigan Ave
Logansport, IN 46947-1526
Phone
(574) 722-5151
Fax
(574) 739-1414
NPI assigned
Jan 5, 2011
Last updated
Jan 5, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 01067082A IN
Child & Adolescent Psychiatry Physician 2084P0804X 01067082A IN Primary

Addresses

Primary practice location

1015 Michigan Ave
Logansport, IN 46947-1526

Mailing address

1015 Michigan Ave
Logansport, IN 46947-1526
Phone (574) 722-5151

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20151230001520 AL Practitioner - Psychiatry 3375724024 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Grayson and Associates PCGroup PAC ID 9032108253, 65 clinicians

Practice addresses (Care Compare)

100 Concourse Pkwy
Suite 101
Birmingham, AL 35244-2905
Phone (205) 444-0420

124 S Memorial Dr
Prattville, AL 36067-3619
Phone (334) 365-0651

2105 E S Blvd
Montgomery, AL 36116-2409
Phone (205) 871-6926

2200 Lakeshore Dr
Suite 150
Birmingham, AL 35209-8832
Phone (205) 871-6923

29 L V Stabler Dr
Greenville, AL 36037-3850
Phone (334) 383-2243

4385 Narrow Lane Rd
Montgomery, AL 36116-2978
Phone (334) 286-3116

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Health Care Authority for Baptist Health, an Affiliate of Uabhs CurrentSince Feb 8, 2026 Accepting new patients
Noahs Ark Child & Family Treatment Center Inc CurrentSince Dec 29, 2018 Accepting new patients
Grayson and Associates PC Psychiatry CurrentSince Dec 1, 2015 Accepting new patients
Health Care Authority for Baptist Health, an Affiliate of Uabhs CurrentSince Feb 8, 2026 Accepting new patients
SVPS Psychiatric Services LLC Psychiatry Past Accepting new patients
Health Care Authority for Baptist Health, an Affiliate of Uabhs Past Accepting new patients
The Health Care Authority for Baptist Health an Affiliate of Uabhs Past Accepting new patients

Locations

1728 5th Ave N
Birmingham, AL 35203
Phone (205) 410-1523

2200 Lakeshore Dr
Ste 150
Homewood, AL 35209
Phone (205) 397-4774

100 Concourse Pkwy
Ste 101
Hoover, AL 35244
Phone (205) 444-0420

4385 Narrow Lane Rd
Montgomery, AL 36116
Phone (334) 286-3116

Organizations & group practices 8

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 3

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": "1294185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294185600000",
    "number": "1588968556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 MICHIGAN AVE",
            "city": "LOGANSPORT",
            "state": "IN",
            "postal_code": "469471526",
            "telephone_number": "574-722-5151",
            "fax_number": "574-739-1414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 MICHIGAN AVE",
            "city": "LOGANSPORT",
            "state": "IN",
            "postal_code": "469471526",
            "telephone_number": "574-722-5151",
            "fax_number": "574-739-1414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOISE",
        "first_name": "DESPINA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-05",
        "last_updated": "2011-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "01067082A",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "IN",
            "license": "01067082A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Logansport, IN

Sources for this page

Verify at the official NPI Registry.