Active NPI
Shohreh Moazami IV, M.D.
- Pediatrics Physician
- Battle Creek, MI
National Provider Identifier
1639179146
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 4301062801
- Practice address
- 2545 Capital Ave SW
Suite 201
Battle Creek, MI 49015-7120 - Phone
- (269) 969-8723
- Fax
- (269) 969-8724
- NPI assigned
- Jul 26, 2005
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 4301062801 | MI | Primary |
Addresses
Primary practice location
2545 Capital Ave SW
Suite 201
Battle Creek, MI 49015-7120
Mailing address
2545 Capital Ave SW
Suite 201
Battle Creek, MI 49015-7120
Phone (269) 969-8723
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12-31350 | Other | MI | UNITED HEALTH CARE |
| 147687 | Other | MI | GREAT LAKES HEALTH PLAN |
| 00994 | Other | MI | HEALTH PLAN OF MICHIGAN |
| 3501310791 | Other | MI | BLUE CROSS BLUE SHEILD |
| 5922108 | Other | MI | AETNA |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301062801 | MI | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1122336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1639179146",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2545 CAPITAL AVE SW",
"address_2": "SUITE 201",
"city": "BATTLE CREEK",
"state": "MI",
"postal_code": "490157120",
"telephone_number": "269-969-8723",
"fax_number": "269-969-8724"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2545 CAPITAL AVE SW",
"address_2": "SUITE 201",
"city": "BATTLE CREEK",
"state": "MI",
"postal_code": "490157120",
"telephone_number": "269-969-8723",
"fax_number": "269-969-8724"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOAZAMI",
"first_name": "SHOHREH",
"name_prefix": "Dr.",
"name_suffix": "IV",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-07-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MI",
"license": "4301062801",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTH CARE",
"identifier": "12-31350",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GREAT LAKES HEALTH PLAN",
"identifier": "147687",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PLAN OF MICHIGAN",
"identifier": "00994",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHEILD",
"identifier": "3501310791",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "5922108",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Battle Creek, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.