Individual provider Active NPI

Dana W Moore, PH.D.

  • Clinical Neuropsychologist
  • Danbury, CT
National Provider Identifier
1851798698
Registry record updated Jan 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
3392 Issued in CT
Practice address
69 Sand Pit Rd
Suite 300
Danbury, CT 06810-4004
Phone
(203) 748-2551
Fax
(203) 790-6375
NPI assigned
Nov 21, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 3392 CT Primary

Addresses

Primary practice location

69 Sand Pit Rd
Suite 300
Danbury, CT 06810-4004

Mailing address

69 Sand Pit Rd
Suite 300
Danbury, CT 06810-4004
Phone (203) 748-2551

Other names 1

  • Dr. Dana Wiebe Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150624002040 CT Practitioner - Clinical Psychologist 6406177658 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nuvance Health Medical Practice CT IncGroup PAC ID 4789597691, 742 clinicians

Practice addresses (Care Compare)

69 Sand Pit Rd
Danbury, CT 06810-4004
Phone (203) 748-2551

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Nuvance Health Medical Practice CT, Inc. CurrentSince Apr 30, 2020 Accepting new patients

Locations

69 Sand Pit Rd
Ste 300
Danbury, CT 06810
Phone (203) 748-2551

69 Sand Pit Rd
Danbury, CT 06810
Phone (203) 748-2551

24 Hospital Ave
Danbury, CT 06810
Phone (203) 739-7118

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1416528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453248000000",
    "number": "1851798698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "69 SAND PIT RD",
            "address_2": "SUITE 300",
            "city": "DANBURY",
            "state": "CT",
            "postal_code": "068104004",
            "telephone_number": "203-748-2551",
            "fax_number": "203-790-6375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "69 SAND PIT RD",
            "address_2": "SUITE 300",
            "city": "DANBURY",
            "state": "CT",
            "postal_code": "068104004",
            "telephone_number": "203-748-2551",
            "fax_number": "203-790-6375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "DANA",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-21",
        "last_updated": "2016-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CT",
            "license": "3392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DANA",
            "last_name": "WIEBE",
            "prefix": "DR.",
            "credential": "PH.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Danbury, CT

Sources for this page

Verify at the official NPI Registry.