NPIMap

Individual provider Active NPI

Jennifer Pratt Moody, MD

  • Physical Medicine & Rehabilitation Physician
  • Scarborough, ME
National Provider Identifier
1770901621
Registry record updated Mar 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
MD29129 Issued in ME
Practice address
92 Campus Dr Ste a
Scarborough, ME 04074-7229
Phone
(207) 885-0011
Fax
(207) 885-5851
NPI assigned
Mar 28, 2014
Last updated
Mar 13, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 295542 NY
Physical Medicine & Rehabilitation Physician 208100000X T4226 TX
Physical Medicine & Rehabilitation Physician 208100000X MD29129 ME Primary

Addresses

Primary practice location

92 Campus Dr Ste a
Scarborough, ME 04074-7229

Mailing address

92 Campus Dr Ste a
Scarborough, ME 04074-7229
Phone (207) 885-0011

Other practice location 1

2000 Medical Dr
Lakeway, TX 78734-4200
Phone (512) 263-4500

Electronic endpoints 2

TypeEndpointUseAffiliation
Other URL PCC
Direct Messaging Address jmoody1206365@direct.sw.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
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
I20250501001263 ME Practitioner - Physical Medicine and Rehabilitation 7416292792 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
University of Louisville School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MainehealthGroup PAC ID 7517860588, 2,616 clinicians

Practice addresses (Care Compare)

22 Bramhall St
Portland, ME 04102-3134
Phone (207) 885-9905

92 Campus Dr
Scarborough, ME 04074-7229

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD29129MEMDPhysical Medicine & Rehabilitation Physician
T4226TXMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mainehealth CurrentSince Apr 28, 2025 Accepting new patients
Scott & White Clinic Current Accepting new patients
Mainehealth CurrentSince Apr 28, 2025 Accepting new patients
Mainehealth Current Accepting new patients
Montefiore Mount Vernon Hospital Past Accepting new patients
Mainehealth Past Accepting new patients

Locations

22 Bramhall St
Portland, ME 04102
Phone (207) 662-2179

92 Campus Dr
Ste A
Scarborough, ME 04074
Phone (207) 885-0011

2401 S 31st St
Temple, TX 76508
Phone (254) 724-2459

Interoperability endpoints

  • Direct secure messaging: jmoody1206365@direct.sw.org
  • Direct secure messaging: jmoody902009@direct.mmc.mainehealth.org

Organizations & group practices 6

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.

Hospital & facility affiliations 38

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1395964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741824000000",
    "number": "1770901621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "92 CAMPUS DR STE A",
            "city": "SCARBOROUGH",
            "state": "ME",
            "postal_code": "040747229",
            "telephone_number": "207-885-0011",
            "fax_number": "207-885-5851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "92 CAMPUS DR STE A",
            "city": "SCARBOROUGH",
            "state": "ME",
            "postal_code": "040747229",
            "telephone_number": "207-885-0011",
            "fax_number": "207-885-5851"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2000 Medical Dr",
            "address_purpose": "LOCATION",
            "city": "Lakeway",
            "state": "TX",
            "postal_code": "787344200",
            "country_code": "US",
            "telephone_number": "512-263-4500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOODY",
        "first_name": "JENNIFER",
        "middle_name": "PRATT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-28",
        "last_updated": "2025-03-13",
        "certification_date": "2025-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NY",
            "license": "295542",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "TX",
            "license": "T4226",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "ME",
            "license": "MD29129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "PCC",
            "affiliation": "N",
            "address_1": "6909 Burnet Ln",
            "city": "Austin",
            "state": "TX",
            "country_code": "US",
            "postal_code": "787572430",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmoody1206365@direct.sw.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2000 Medical Dr",
            "city": "Lakeway",
            "state": "TX",
            "country_code": "US",
            "postal_code": "787344200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Scarborough, ME

Sources for this page

Verify at the official NPI Registry.