Individual provider Active NPI

Surinder Moonga, MD

  • Psychiatry Physician
  • Baltimore, MD
National Provider Identifier
1851898019
Registry record updated Apr 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
D0092816 Issued in MD
Practice address
6501 N Charles St
Baltimore, MD 21204-6819
Phone
(410) 938-3000
NPI assigned
Apr 12, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X A195179 CA
Psychiatry Physician 2084P0800X D0092816 MD Primary

Addresses

Primary practice location

6501 N Charles St
Baltimore, MD 21204-6819

Mailing address

6501 N Charles St
Baltimore, MD 21204-6819
Phone (410) 938-3000

Other practice location 1

1162 Montgomery Dr Ste 200
Santa Rosa, CA 95405-4802
Phone (707) 890-4100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, CA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220908000031 MD Practitioner - Psychiatry 2062764285 Reassigns benefits to 1 organization
I20240426003378 CA Practitioner - Psychiatry 2062764285 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

1162 Montgomery Dr
Suite 200
Santa Rosa, CA 95405-4802
Phone (707) 890-4100

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A195179CAMDPsychiatry Physician
D0092816MDMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation CurrentSince Apr 15, 2024 Accepting new patients
Providence Medical Foundation Current Accepting new patients
Geisinger Clinic CurrentSince Jul 5, 2022 Accepting new patients
Providence Medical Foundation CurrentSince Apr 15, 2024 Accepting new patients

Locations

200 W Ctr St Promenade
Ste 300
Anaheim, CA 92805
Phone (714) 449-4841

1100 Trancas St
Ste 209
Napa, CA 94558
Phone (707) 251-1850

1162 Montgomery Dr
Ste 200
Santa Rosa, CA 95405
Phone (707) 890-4100

1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210

500 Doyle Park Dr
Ste 100
Santa Rosa, CA 95405
Phone (714) 449-4842

1209 N Charles St
Baltimore, MD 21201

100 N Academy Ave
Danville, PA 17822

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: smoonga3342919@oc.providencedirect.org

Organizations & group practices 5

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": "1523491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713225600000",
    "number": "1851898019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6501 N CHARLES ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212046819",
            "telephone_number": "410-938-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6501 N CHARLES ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212046819",
            "telephone_number": "410-938-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1162 Montgomery Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Santa Rosa",
            "state": "CA",
            "postal_code": "954054802",
            "country_code": "US",
            "telephone_number": "707-890-4100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOONGA",
        "first_name": "SURINDER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-12",
        "last_updated": "2024-04-16",
        "certification_date": "2024-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A195179",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MD",
            "license": "D0092816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.