NPIMap

Organization Active NPI

Moonlight Pediatrics LLC

Doing business as Moonlit Pediatrics

  • Pediatrics Physician
  • Swansea, IL
National Provider Identifier
1780295683
Registry record updated Aug 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
MOONLIGHT PEDIATRICS LLC
Doing business as
Moonlit Pediatrics
Practice address
1 Bronze Pointe Blvd Ste 1a
Swansea, IL 62226-1045
Phone
(216) 778-0808
NPI assigned
Aug 13, 2020
Last updated
Aug 18, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2020

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

Authorized official

Name
Dr. Qamar Zaman, MDNPI 1497036552
Title
Director
Phone
(216) 778-0808

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary
Urgent Care Clinic/Center 261QU0200X

Addresses

Primary practice location

1 Bronze Pointe Blvd Ste 1a
Swansea, IL 62226-1045

Mailing address

866 Revere Dr
Saint Louis, MO 63141-8818

Other names 1

  • MOONLIT PEDIATRICS Doing business as

National Provider Directory

National Provider Directory

Locations

1 Bronze Pointe Blvd
Ste 1A
Swansea, IL 62226
Phone (216) 778-0808

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1597276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597708800000",
    "number": "1780295683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "866 REVERE DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BRONZE POINTE BLVD STE 1A",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622261045",
            "telephone_number": "216-778-0808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOONLIGHT PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-13",
        "last_updated": "2020-08-18",
        "certification_date": "2020-08-18",
        "status": "A",
        "authorized_official_last_name": "ZAMAN",
        "authorized_official_first_name": "QAMAR",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "216-778-0808",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MOONLIT PEDIATRICS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Swansea, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.