Stacy Renae Moody, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019026581 Issued in IL

Practice address

3120 Maryville Rd
Granite City, IL 62040-5189

Phone

(618) 797-9940

NPI assigned

Sep 20, 2006

Last updated

Oct 30, 2013By 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

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Larry W. Crocker DMD, PC

  dba Dentistry with TLC

  • General Practice Dentistry
  • Godfrey, IL
  • NPI 1215034608
  NPD (past)
• Midwest Family Dentistry PC

  • Dentist
  • Granite City, IL
  • NPI 1558484410
  NPD (past)

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383091200000",
    "number": "1700984317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3120 MARYVILLE RD",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620405189",
            "telephone_number": "618-797-9940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3120 MARYVILLE RD",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620405189",
            "telephone_number": "618-797-9940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOODY",
        "first_name": "STACY",
        "middle_name": "RENAE",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2013-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019026581",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Jason Miller
• Terri Milton, LPC
• Elizabeth Patricia Mincy, APRN-C
• Mohammad R Ashraf MD
• Robert Montgomery
• Jillian L Moreno, HIS
• Emily Mouyard
• Roger Michael Mueller, D.M.D.
• Multi-Care Specialists SC
• Ana Maria Murillo, DC

• General Practice Dentistry in Granite City, IL
• Providers in Granite City, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2013; 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.