Individual provider Active NPI

Thomas August Moran, MD

  • Sports Medicine (Family Medicine) Physician
  • Skokie, IL
National Provider Identifier
1649534447
Registry record updated Apr 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
036139014 Issued in IL
Practice address
9650 Gross Point Rd.
Suite 2900
Skokie, IL 60076
Phone
(847) 866-7846
Fax
(224) 251-4568
NPI assigned
Jun 27, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036139014 IL
Sports Medicine (Family Medicine) Physician 207QS0010X 036139014 IL Primary

Addresses

Primary practice location

9650 Gross Point Rd.
Suite 2900
Skokie, IL 60076

Mailing address

9650 Gross Point Rd.
Suite 2900
Skokie, IL 60076-1214
Phone (847) 866-7846

Other practice location 1

2650 Ridge Ave
Suite 1304
Evanston, IL 60201-1718
Phone (708) 738-9909

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tmoran265357@direct.northshore.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170621002200 IL Practitioner - Sports MedicinePractitioner - Family Practice 4789829680 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Sports MedicineAlso: Family Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

9600 Gross Point Rd
Skokie, IL 60076-1214
Phone (847) 677-9600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.9 of 100Reported as group
Quality
75.91
Promoting interoperability
99
Improvement activities
40
Cost
74.6

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group Family Medicine CurrentSince Aug 1, 2017 Accepting new patients
Endeavor Health Medical Group CurrentSince Aug 1, 2017 Accepting new patients
Endeavor Health Clinical Operations Past Accepting new patients

Locations

9532 Eagle Way
Chicago, IL 60678

2650 Ridge Ave
#1223
Evanston, IL 60201
Phone (847) 982-3172

2650 Ridge Ave
Ste 1223
Evanston, IL 60201
Phone (847) 982-3175

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

2650 Ridge Ave
Ste 1304
Evanston, IL 60201
Phone (847) 570-2700

2180 Pfingsten Rd
Ste 3100
Glenview, IL 60026

2180 Pfingsten Rd
Glenview, IL 60026
Phone (847) 503-1000

9650 Gross Point Rd
Ste 2900
Skokie, IL 60076

9600 Gross Point Rd
Skokie, IL 60076
Phone (847) 677-9600

Interoperability endpoints

  • Direct secure messaging: tmoran265357@direct.northshore.org

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 5

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": "1340755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617753600000",
    "number": "1649534447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9650 GROSS POINT RD.",
            "address_2": "SUITE 2900",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600761214",
            "telephone_number": "847-866-7846",
            "fax_number": "224-251-4568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9650 GROSS POINT RD.",
            "address_2": "SUITE 2900",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "60076",
            "telephone_number": "847-866-7846",
            "fax_number": "224-251-4568"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2650 Ridge Ave",
            "address_2": "Suite 1304",
            "address_purpose": "LOCATION",
            "city": "Evanston",
            "state": "IL",
            "postal_code": "602011718",
            "country_code": "US",
            "telephone_number": "708-738-9909",
            "fax_number": "847-657-1823",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MORAN",
        "first_name": "THOMAS",
        "middle_name": "AUGUST",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-27",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036139014",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "IL",
            "license": "036139014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tmoran265357@direct.northshore.org",
            "affiliation": "N",
            "address_1": "9650 Gross Point Rd.",
            "address_2": "Suite 2900",
            "city": "Skokie",
            "state": "IL",
            "country_code": "US",
            "postal_code": "60076",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Skokie, IL

Sources for this page

Verify at the official NPI Registry.