NPIMap

Individual provider Active NPI

Jacqueline Denise Moses, M.D.

  • Psychiatry Physician
  • Dewitt, MI
National Provider Identifier
1699714279
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
4301080311 Issued in MI
Practice address
12508 Burlingame Dr
Dewitt, MI 48820-7905
Phone
(517) 669-8110
NPI assigned
Jun 6, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 4301080311 MI Primary

Addresses

Primary practice location

12508 Burlingame Dr
Dewitt, MI 48820-7905

Mailing address

12508 Burlingame Dr
Dewitt, MI 48820-7905
Phone (517) 669-8110

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20081223000566 MI Practitioner - PsychiatryPractitioner - Neurology 8426157033 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Parkwest Medical Center Past Accepting new patients
Poplar Bluff Hma Physician Management, LLC Psychiatry Past Accepting new patients
Bootheel Counseling Services PastSince Dec 3, 2023 Accepting new patients
Mercy Health Partners Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: jacqueline.moses@cernerdirect.coxhealth.com

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1699714279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12508 BURLINGAME DR",
            "city": "DEWITT",
            "state": "MI",
            "postal_code": "488207905",
            "telephone_number": "517-669-8110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12508 BURLINGAME DR",
            "city": "DEWITT",
            "state": "MI",
            "postal_code": "488207905",
            "telephone_number": "517-669-8110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSES",
        "first_name": "JACQUELINE",
        "middle_name": "DENISE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4301080311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dewitt, MI

Sources for this page

Verify at the official NPI Registry.