NPIMap

Individual provider Active NPI

Derek Lee Moody

  • Orthopaedic Surgery of the Spine Physician
  • Victoria, TX
National Provider Identifier
1841752458
Registry record updated Jan 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X
License
U9610 Issued in TX
Practice address
6404 Nursery Dr Ste 202
Victoria, TX 77904-1688
Phone
(361) 576-0633
Fax
(361) 576-0639
NPI assigned
Apr 2, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery of the Spine Physician 207XS0117X U9610 TX Primary

Addresses

Primary practice location

6404 Nursery Dr Ste 202
Victoria, TX 77904-1688

Mailing address

6404 Nursery Dr Ste 202
Victoria, TX 77904-1688
Phone (361) 576-0633

Other practice location 1

6400 Fannin St
Houston, TX 77030-1521
Phone (713) 486-7500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20250213003957 TX Practitioner - Orthopedic Surgery 9931639390 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
University of Texas Medical School at Houston, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

6404 Nursery Dr
Suite 202
Victoria, TX 77904-1721
Phone 3615760633101

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion37
Laminectomy or laminotomy (partial removal of spine bones)14

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
U9610TXMDOrthopaedic Surgery of the Spine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Victoria Orthopedic Center PLLC CurrentSince Apr 1, 2025 Accepting new patients
Victoria Orthopedic Center PLLC Orthopaedic Surgery of the Spine CurrentSince Apr 1, 2025 Accepting new patients
Citizens Medical Center County of Victoria Past Accepting new patients

Locations

6404 Nursery Dr
Ste 202
Victoria, TX 77904
Phone (361) 333-5321

605 E San Antonio St
Ste 520E
Victoria, TX 77901
Phone (361) 576-0633

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EDBEBD

Organizations & group practices 3

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.

Hospital & facility affiliations 5

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": "1554163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737331200000",
    "number": "1841752458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6404 NURSERY DR STE 202",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779041688",
            "telephone_number": "361-576-0633",
            "fax_number": "361-576-0639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6404 NURSERY DR STE 202",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779041688",
            "telephone_number": "361-576-0633",
            "fax_number": "361-576-0639"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6400 Fannin St",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770301521",
            "country_code": "US",
            "telephone_number": "713-486-7500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOODY",
        "first_name": "DEREK",
        "middle_name": "LEE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-02",
        "last_updated": "2025-01-20",
        "certification_date": "2025-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "TX",
            "license": "U9610",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Victoria, TX

Sources for this page

Verify at the official NPI Registry.