NPIMap

Individual provider Active NPI

Justin Dean Moody, D.O.

  • Emergency Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1639370489
Registry record updated Apr 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
2008014393 Issued in MO
Practice address
10010 Kennerly Rd
Saint Louis, MO 63128-2106
Phone
(314) 525-1906
NPI assigned
May 30, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2008014393 MO
Emergency Medicine Physician 207P00000X 036119226 IL
Emergency Medicine Physician 207P00000X 2008014393 MO Primary

Addresses

Primary practice location

10010 Kennerly Rd
Saint Louis, MO 63128-2106

Mailing address

PO Box 776084
Chicago, IL 60677-6084
Phone (314) 364-4200

Other practice location 1

1000 E Cherry St
Troy, MO 63379-1513
Phone (636) 528-8551

Other practice location 2

1400 US Highway 61
Festus, MO 63028-4100
Phone (636) 933-1111

Other practice location 3

615 S New Ballas Rd
Saint Louis, MO 63141-8221
Phone (314) 251-6090

Other practice location 4

901 E 5th St
Washington, MO 63090-3127
Phone (636) 239-8011

Other practice location 5

434 N West St
Perryville, MO 63775-1359
Phone (573) 547-2536

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20090501000126 MO Practitioner - Emergency Medicine 0941386700 Reassigns benefits to 13 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeastern Emergency Physicians of Memphis LLCGroup PAC ID 5395643209, 92 clinicians

Practice addresses (Care Compare)

7245 Raider Rd
Bonne Terre, MO 63628-3767
Phone (573) 358-1400

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Aco Clinical Services Inc Emergency Medicine CurrentSince Mar 7, 2020 Accepting new patients
Mercy Hospital Jefferson CurrentSince Feb 1, 2020 Accepting new patients
Mercy Hospital South Emergency Medicine CurrentSince Feb 1, 2020 Accepting new patients
Mercy Hospitals East Communities Emergency Medicine CurrentSince Feb 1, 2020 Accepting new patients
Ste. Genevieve County Memorial Hospital CurrentSince Jul 1, 2025 Accepting new patients
Mercy Hospital Perry Family Medicine CurrentSince Sep 17, 2024 Accepting new patients
Mercy Hospital Lincoln Family Medicine CurrentSince Feb 1, 2020 Accepting new patients
Ste Genevieve County Memorial Hospital CurrentSince Jul 1, 2025 Accepting new patients
Mercy Hospitals East Communities Family Medicine CurrentSince Feb 1, 2020 Accepting new patients
Ste Genevieve County Memorial Hospital CurrentSince Jan 1, 2026 Accepting new patients
Mercy Hospitals East Communities CurrentSince Feb 1, 2020 Accepting new patients
Mercy Hospitals East Communities Emergency Medicine CurrentSince Feb 1, 2020 Accepting new patients
Mercy Hospital South CurrentSince Feb 1, 2020 Accepting new patients
St Louis Pathology Assoc Inc. Current Accepting new patients
Analytical Pathology Services LTD Current Accepting new patients
Mercy Hospital Jefferson CurrentSince Feb 1, 2020 Accepting new patients
Mercy Hospital Perry Emergency Medicine CurrentSince Sep 17, 2024 Accepting new patients
Midwest Emergency Associates-Fenton, LLC Emergency Medicine Past Accepting new patients

Locations

15740 South Outer 40 Rd
Chesterfield, MO 63017
Phone (636) 735-4268

1701 Lacey St
Cpe Girardeau, MO 63701
Phone (573) 334-4822

1400 US Highway 61
Crystal Cty, MO 63028
Phone (636) 933-1111

434 N West St
Perryville, MO 63775
Phone (573) 547-2530

10010 Kennerly Rd
Saint Louis, MO 63128
Phone (314) 525-1328

615 S New Ballas Rd
Saint Louis, MO 63141
Phone (314) 251-4687

1235 E Cherokee St
Springfield, MO 65804
Phone (417) 820-2115

800 Ste Genevieve Dr
Ste Genevieve, MO 63670
Phone (573) 883-2571

900 E Cherry St
Troy, MO 63379
Phone (636) 528-8585

1000 E Cherry St
Troy, MO 63379
Phone (636) 528-3327

901 E 5th St
Washington, MO 63090
Phone (636) 239-8000

Organizations & group practices 20

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.

View all 20

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776729600000",
    "number": "1639370489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776084",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776084",
            "telephone_number": "314-364-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10010 KENNERLY RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282106",
            "telephone_number": "314-525-1906"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 E Cherry St",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "MO",
            "postal_code": "633791513",
            "country_code": "US",
            "telephone_number": "636-528-8551",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1400 US Highway 61",
            "address_purpose": "LOCATION",
            "city": "Festus",
            "state": "MO",
            "postal_code": "630284100",
            "country_code": "US",
            "telephone_number": "636-933-1111",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "615 S New Ballas Rd",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631418221",
            "country_code": "US",
            "telephone_number": "314-251-6090",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "901 E 5th St",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "MO",
            "postal_code": "630903127",
            "country_code": "US",
            "telephone_number": "636-239-8011",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "434 N West St",
            "address_purpose": "LOCATION",
            "city": "Perryville",
            "state": "MO",
            "postal_code": "637751359",
            "country_code": "US",
            "telephone_number": "573-547-2536",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOODY",
        "first_name": "JUSTIN",
        "middle_name": "DEAN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-30",
        "last_updated": "2026-04-21",
        "certification_date": "2026-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2008014393",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036119226",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MO",
            "license": "2008014393",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.