Active NPI
Jordan Moody
- Sports Medicine (Preventive Medicine) Physician
- Columbia, SC
National Provider Identifier
1629577549
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Preventive Medicine) Physician
- License
- SC500634
- Practice address
- 811 Polo Rd Apt 616
Columbia, SC 29223-4445 - Phone
- (803) 586-2132
- NPI assigned
- Feb 6, 2018
- 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 |
|---|---|---|---|---|
| Sports Medicine (Preventive Medicine) Physician | 2083S0010X | SC500634 | SC | Primary |
Addresses
Primary practice location
811 Polo Rd Apt 616
Columbia, SC 29223-4445
Mailing address
811 Polo Rd Apt 616
Columbia, SC 29223-4445
Phone (803) 586-2132
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SC500634 | SC | MD | Sports Medicine (Preventive Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1517875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1517875200000",
"number": "1629577549",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "811 POLO RD APT 616",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292234445",
"telephone_number": "803-586-2132"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "811 POLO RD APT 616",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292234445",
"telephone_number": "803-586-2132"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOODY",
"first_name": "JORDAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-02-06",
"last_updated": "2018-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "2083S0010X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Sports Medicine",
"state": "SC",
"license": "SC500634",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.