William Edward Moredock, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071.003906 Issued in IL

Practice address

1200 W. Washington Street
Springfield, IL 62702-4794

Phone

(217) 787-1595

NPI assigned

Nov 6, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372636800000",
    "number": "1720167026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 CHANDLERWOOD",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627116081",
            "telephone_number": "217-793-3612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W. WASHINGTON STREET",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627024794",
            "telephone_number": "217-787-1595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOREDOCK",
        "first_name": "WILLIAM",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-06",
        "last_updated": "2013-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.003906",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSIL",
            "identifier": "08406629",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "174554000",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11443979",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "255240",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicol Moore
• Randall D. Moore, CRNA
• Ross Aaron Moore, M.D.
• William Moore, MD
• Helen L Moose, CNM-MS
• Javier Moreno
• Timothy Morenz, LCPC
• Abigail Lauren Morgan, DNP, FNP-C
• Anne B Morgan, PHD
• Cornelius Morgan Jr.

• Clinical Psychologist in Springfield, IL
• Providers in Springfield, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 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.