Active NPI
Jerry L Moench, MD
- Cardiovascular Disease Physician
- Sioux Falls, SD
National Provider Identifier
1619920311
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- 1548
- Practice address
- 4520 W 69TH St
Sioux Falls, SD 57108-8148 - Phone
- (605) 977-5000
- Fax
- (605) 977-5377
- NPI assigned
- May 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | 1548 | SD | Primary |
Addresses
Primary practice location
4520 W 69TH St
Sioux Falls, SD 57108-8148
Mailing address
PO Box 5009
Sioux Falls, SD 57117-5009
Phone (605) 977-5000
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 165027 | Other | UCARE | |
| 6001200 | Medicaid | SD | |
| 1106195 | Medicaid | IA | |
| 24681 | Other | HEALTH PARTNERS | |
| 92589MO | Other | MN | MN BCBS - PLAN 91057NO |
| 931451029038 | Other | PREFERRED ONE | |
| 0009604 | Other | SD | SD BCBS |
| 538R5MO | Other | MN | MN BCBS - PLAN 538R2NO |
| 1548 | Other | SD | DAKOTACARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25461 | MN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1206316800000",
"number": "1619920311",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5009",
"city": "SIOUX FALLS",
"state": "SD",
"postal_code": "571175009",
"telephone_number": "605-977-5000",
"fax_number": "605-977-5377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4520 W 69TH ST",
"city": "SIOUX FALLS",
"state": "SD",
"postal_code": "571088148",
"telephone_number": "605-977-5000",
"fax_number": "605-977-5377"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOENCH",
"first_name": "JERRY",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-17",
"last_updated": "2008-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "SD",
"license": "1548",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "165027",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6001200",
"state": "SD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1106195",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "24681",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MN BCBS - PLAN 91057NO",
"identifier": "92589MO",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "931451029038",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SD BCBS",
"identifier": "0009604",
"state": "SD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MN BCBS - PLAN 538R2NO",
"identifier": "538R5MO",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DAKOTACARE",
"identifier": "1548",
"state": "SD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sioux Falls, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.