Active NPI
Moises Fajardo
- Nurse Practitioner
- Clawson, MI
National Provider Identifier
1740683069
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 4704267838
- Practice address
- 1402 W 14 Mile Rd
Clawson, MI 48017-1499 - Phone
- (866) 389-2727
- NPI assigned
- Oct 1, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 4704267838 | MI | |
| Nurse Practitioner | 363L00000X | 4704267838 | MI | Primary |
Addresses
Primary practice location
1402 W 14 Mile Rd
Clawson, MI 48017-1499
Mailing address
2445 Claymont Dr
Troy, MI 48098-2493
Phone (248) 792-7114
Other names 1
- Moises Romeo Fajardo
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mfajardo25000@direct.beaumont.edu |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141209002180 | MI | Practitioner - Nurse Practitioner | 1052633690 | Reassigns benefits to 2 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
28100 Grand River Ave
Farmington Hills, MI 48336-5970
44201 Dequindre Rd
Troy, MI 48085-1117
Phone (248) 964-0535
44344 Dequindre Rd
Sterling Heights, MI 48314-1040
Hospital & facility affiliations
- Beaumont Hospital, Troy
- Beaumont Hospital - Farmington Hills
- Beaumont Hospital Royal Oak
- Beaumont Hospital - Grosse Pointe
Merit-based Incentive Payment System (MIPS)
- Final score
- 84.37 of 100
- Quality
- 66.73
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 70.98
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704267838 | MI | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Beaumont Medical Group- Specialty Services | Current | Accepting new patients | |
| John Kitzmiller M.D. PC | Current | Accepting new patients |
Locations
28100 Grand River Ave
Ste 301
Farmington Hills, MI 48336
Phone (947) 521-1320
468 Cadieux Rd
Grosse Pt Wds, MI 48230
Phone (313) 343-1000
1455 S Lapeer Rd
Ste 200
Lake Orion, MI 48360
Phone (248) 693-1986
3601 W 13 Mile Rd
Royal Oak, MI 48073
Interoperability endpoints
- mfajardo1233038@epic00.shdirect.org
Organizations & group practices 2
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.
-
- Addiction Medicine (Family Medicine) Physician
- Lake Orion, MI
- NPI 1518393800
MI
Hospital & facility affiliations 12
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": "1412121600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603324800000",
"number": "1740683069",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2445 CLAYMONT DR",
"city": "TROY",
"state": "MI",
"postal_code": "480982493",
"telephone_number": "248-792-7114"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1402 W 14 MILE RD",
"city": "CLAWSON",
"state": "MI",
"postal_code": "480171499",
"telephone_number": "866-389-2727"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAJARDO",
"first_name": "MOISES",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-10-01",
"last_updated": "2020-10-22",
"certification_date": "2020-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MI",
"license": "4704267838",
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MI",
"license": "4704267838",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mfajardo25000@direct.beaumont.edu",
"affiliation": "N",
"address_1": "1402 W 14 Mile Rd",
"city": "Clawson",
"state": "MI",
"country_code": "US",
"postal_code": "480171499",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "MOISES ROMEO",
"last_name": "FAJARDO",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Clawson, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2020; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.