NPIMap

Individual provider Active NPI

Moges Sisay, MD

  • Rheumatology Physician
  • Evansville, IN
National Provider Identifier
1649264896
Registry record updated May 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
License
01053981A Issued in IN
Practice address
3801 Bellemeade Ave Ste 300
Evansville, IN 47714-0113
Phone
(812) 485-1400
NPI assigned
Sep 2, 2005
Last updated
May 18, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rheumatology Physician 207RR0500X 01053981A IN Primary

Addresses

Primary practice location

3801 Bellemeade Ave Ste 300
Evansville, IN 47714-0113

Mailing address

3801 Bellemeade Ave Ste 300
Evansville, IN 47714-0113

Other practice location 1

4411 Washington Ave
Evansville, IN 47714-0805
Phone (812) 437-2340

Other identifiers 2

IdentifierTypeStateIssuer
200317280AMedicaidIN
64030471MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20100809000837 IN Practitioner - Rheumatology 7517090772 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Rheumatology
Education
Other, 1982
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

4411 Washington Ave
Evansville, IN 47714-0805

5015 E Plaza E Blvd
Evansville, IN 47715-2861
Phone (812) 437-2340

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Rheumetology Arthritis Immunology Rheumatology CurrentSince May 1, 2013 Accepting new patients
Tri-State Arthritis & Rheumatology Center, LLC Rheumatology Past Accepting new patients
University of Miami Rheumatology Past Accepting new patients

Locations

4411 Washington Ave
Evansville, IN 47714
Phone (812) 437-2340

5015 E Plaza East Blvd
Evansville, IN 47715
Phone (812) 437-2340

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EEDFBA/Endpoint/EEDFBA

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1125619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684368000000",
    "number": "1649264896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 BELLEMEADE AVE STE 300",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477140113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 BELLEMEADE AVE STE 300",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477140113",
            "telephone_number": "812-485-1400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4411 Washington Ave",
            "address_purpose": "LOCATION",
            "city": "Evansville",
            "state": "IN",
            "postal_code": "477140805",
            "country_code": "US",
            "telephone_number": "812-437-2340",
            "fax_number": "812-491-1972",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SISAY",
        "first_name": "MOGES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-02",
        "last_updated": "2023-05-18",
        "certification_date": "2023-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "IN",
            "license": "01053981A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200317280A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64030471",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

Verify at the official NPI Registry.