Individual provider Active NPI

Jared L Moon, DPM

  • Podiatrist
  • Crown Point, IN
National Provider Identifier
1649546284
Registry record updated Aug 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
99053018A Issued in IN
Practice address
10607 Randolph St
Crown Point, IN 46307-7504
Phone
(262) 366-7994
NPI assigned
Mar 28, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X POD001156 GA
Podiatrist 213E00000X 99053018A IN Primary

Addresses

Primary practice location

10607 Randolph St
Crown Point, IN 46307-7504

Mailing address

10607 Randolph St
Crown Point, IN 46307-7504
Phone (262) 366-7994

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121226000161 IN Practitioner - Podiatry 9032362041 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Care Network IncGroup PAC ID 3678737012, 378 clinicians

Practice addresses (Care Compare)

1500 S Lake Park Ave
Hobart, IN 46342-6638

9130 Columbia Ave
Munster, IN 46321-2932

Hospital & facility affiliations

  • Powers Home Health Services Home health agency, Hobart, IN, CCN 157313
  • St Mary Medical Center Inc Hospital, Hobart, IN, CCN 150034
  • St Catherine Hospital Inc Hospital, East Chicago, IN, CCN 150008
  • Community Hospital Hospital, Munster, IN, CCN 150125
  • Powers Health Rehabilitation Center Inpatient rehabilitation facility, Crown Point, IN, CCN 153045

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue236
Removal of nail tissue22
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
POD001156GAMDPodiatrist
99053018AINMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Community Care Network Inc CurrentSince Oct 1, 2012 Accepting new patients

Locations

1500 S Lake Park Ave
#402
Hobart, IN 46342
Phone (219) 945-4488

1500 S Lake Park Ave
Hobart, IN 46342
Phone (219) 942-0551

9130 Columbia Ave
Ste A
Munster, IN 46321
Phone (219) 365-1166

Interoperability endpoints

  • Direct secure messaging: jmoon38974@ssdirect.comhs.org

Organizations & group practices 1

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.

Hospital & facility affiliations 6

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": "1332892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1345161600000",
    "number": "1649546284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10607 RANDOLPH ST",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463077504",
            "telephone_number": "262-366-7994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10607 RANDOLPH ST",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463077504",
            "telephone_number": "262-366-7994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOON",
        "first_name": "JARED",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-03-28",
        "last_updated": "2012-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "GA",
            "license": "POD001156",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IN",
            "license": "99053018A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crown Point, IN

Sources for this page

Verify at the official NPI Registry.