Individual provider Active NPI

Jonathan Keith Moy, D.C.

  • Chiropractor
  • Brookline, MA
National Provider Identifier
1861552978
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
804 Issued in MA
Practice address
1093 Beacon St
Suite 204
Brookline, MA 02446-5623
Phone
(617) 566-0934
Fax
(617) 734-0066
NPI assigned
Dec 11, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 804 MA Primary

Addresses

Primary practice location

1093 Beacon St
Suite 204
Brookline, MA 02446-5623

Mailing address

1093 Beacon St
Suite 204
Brookline, MA 02446-5623
Phone (617) 566-0934

Other identifiers 2

IdentifierTypeStateIssuer
712115OtherMATUFTS HEALTH PLANS
Y35565OtherMABLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040107000351 MA Practitioner - Chiropractic 0749189926 Practice locations: Brookline, MA

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1093 Beacon St
Suite 202
Brookline, MA 02446-5623

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
804MAMDSurgical Physician Assistant

NPI Registry JSON

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1861552978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1093 BEACON ST",
            "address_2": "SUITE 204",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "024465623",
            "telephone_number": "617-566-0934",
            "fax_number": "617-734-0066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1093 BEACON ST",
            "address_2": "SUITE 204",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "024465623",
            "telephone_number": "617-566-0934",
            "fax_number": "617-734-0066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOY",
        "first_name": "JONATHAN",
        "middle_name": "KEITH",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MA",
            "license": "804",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLANS",
            "identifier": "712115",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "Y35565",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookline, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.