Active NPI
Brian Moloney, M.D.
- Family Medicine Physician
- South Bend, IN
National Provider Identifier
1750337762
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 01027627
- Practice address
- 1122 S Ironwood Dr
South Bend, IN 46615-1618 - Phone
- (574) 472-6699
- Fax
- (574) 472-6698
- NPI assigned
- May 25, 2006
- Last updated
- Feb 25, 2009
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 01027627 | IN | Primary |
Addresses
Primary practice location
1122 S Ironwood Dr
South Bend, IN 46615-1618
Mailing address
PO Box 6309
South Bend, IN 46660-6309
Phone (574) 472-6700
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000215987 | Other | IN | BCBS |
| 021236800 | Other | IN | FEDERAL BLACK LUNG |
| 100222170A | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01027627 | IN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Saint Joseph Regional Medical Center, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Saint Joseph Medical Group
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- Plymouth, IN
- NPI 1225082878
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235520000000",
"number": "1750337762",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 6309",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466606309",
"telephone_number": "574-472-6700",
"fax_number": "574-472-6746"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1122 S IRONWOOD DR",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466151618",
"telephone_number": "574-472-6699",
"fax_number": "574-472-6698"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOLONEY",
"first_name": "BRIAN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-25",
"last_updated": "2009-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IN",
"license": "01027627",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "000000215987",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL BLACK LUNG",
"identifier": "021236800",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100222170A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.