Individual provider Active NPI

Matthew David Moslener, MD

  • Sports Medicine (Family Medicine) Physician
  • Belleville, IL
National Provider Identifier
1609003391
Registry record updated May 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
125-057058 Issued in IL
Practice address
180 S 3Rd St
Suite 400
Belleville, IL 62220
Phone
(618) 233-7880
NPI assigned
Jun 19, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 29, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 036.124277 IL
Sports Medicine (Family Medicine) Physician 207QS0010X 125-057058 IL Primary

Addresses

Primary practice location

180 S 3Rd St
Suite 400
Belleville, IL 62220

Mailing address

1037 Yale Ave
Richmond Heights, MO 63117-1820

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20100304000040 IL Practitioner - Emergency MedicinePractitioner - Family Practice 8426193285 Reassigns benefits to 1 organization
I20190912002668 IL Practitioner - Family Practice 8426193285

Care Compare profile

Medicare Care Compare
Specialty
Emergency MedicineAlso: Family Practice
Education
Jefferson Medical College of Thomas Jefferson University, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergency Services Midwest SCGroup PAC ID 2769746056, 37 clinicians

Practice addresses (Care Compare)

4500 Memorial Dr
Belleville, IL 62226-5360
Phone (618) 257-5644

Hospital & facility affiliations

  • Memorial Hospital Hospital, Belleville, IL, CCN 140185
  • Missouri Baptist Medical Center Hospital, Saint Louis, MO, CCN 260108
  • Christian Hospital Northeast Hospital, Saint Louis, MO, CCN 260180
  • Missouri Baptist Sullivan Hospital Hospital, Sullivan, MO, CCN 261337

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.124277ILMDEmergency Medicine Physician
125-057058ILMDSports Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Services Midwest SC Emergency Medicine CurrentSince Jun 1, 2018 Accepting new patients

Locations

1404 Cross St
Shiloh, IL 62269
Phone (618) 607-1000

4500 Memorial Dr
Swansea, IL 62226
Phone (618) 233-7750

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 and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1245369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527552000000",
    "number": "1609003391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1037 YALE AVE",
            "city": "RICHMOND HEIGHTS",
            "state": "MO",
            "postal_code": "631171820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 S 3RD ST",
            "address_2": "SUITE 400",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "62220",
            "telephone_number": "618-233-7880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSLENER",
        "first_name": "MATTHEW",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-19",
        "last_updated": "2018-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036.124277",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "IL",
            "license": "125-057058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Belleville, IL

Sources for this page

Verify at the official NPI Registry.