Ilene Rubowitz Moore, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

45291 Issued in MN

Practice address

14001 Ridgedale Dr Ste 100
Hopkins, MN 55305-1781

Phone

(952) 473-0211

NPI assigned

Mar 24, 2006

Last updated

Jan 12, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• West Side Community Health Services, Inc.

  dba McDonough Homes Clinic

  • Federally Qualified Health Center (FQHC)
  • Saint Paul, MN
  • NPI 1821149964
  Medicare reassignment NPD
• Southside Community Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Minneapolis, MN
  • NPI 1538137757
  NPD
• Southside Community Health Services, Inc.

  • Family Medicine Physician
  • Stillwater, MN
  • NPI 1578680872
  NPD
• Southside Community Health Services, Inc.

  • Family Medicine Physician
  • Minneapolis, MN
  • NPI 1679690952
  NPD
• Wayzata Children's Clinic P.a.

  • Pediatrics Physician
  • Minnetonka, MN
  • NPI 1023081577
  NPD
• West Side Community Health Services, Inc.

  dba MINNESOTA COMMUNITY CARE MBC - St. Paul

  • Federally Qualified Health Center (FQHC)
  • Saint Paul, MN
  • NPI 1043187289
  NPD
• West Side Community Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Saint Paul, MN
  • NPI 1932392727
  NPD

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705017600000",
    "number": "1659331445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14001 RIDGEDALE DR",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553051753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14001 RIDGEDALE DR STE 100",
            "city": "HOPKINS",
            "state": "MN",
            "postal_code": "553051781",
            "telephone_number": "952-473-0211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "ILENE",
        "middle_name": "RUBOWITZ",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-24",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "45291",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "913119100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Zakiriya Hussain Mohamed
• Hussein A Mohamoud
• Ediris Mohamud
• Sharmarke Mohamud
• Lauren Mongelluzzo, CMT
• Stephen Henry Moore, MD
• Darla Moran, PA-C
• Susan Morgan, RN
• Quintin Morris, DPT
• Stacy C Mosiman, PT

• Pediatrics Physician in Hopkins, MN
• Providers in Hopkins, MN by specialty
• Pediatrics Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.