NPIMap

Individual provider Active NPI

Keith A Moench, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Saint Paul, MN
National Provider Identifier
1861635435
Registry record updated Dec 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
52609 Issued in MN
Practice address
295 Phalen Blvd
Saint Paul, MN 55130-2400
Phone
(651) 495-6200
NPI assigned
Apr 13, 2009
Last updated
Dec 2, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Physical Medicine & Rehabilitation Physician 208100000X 52609 MN Primary

Addresses

Primary practice location

295 Phalen Blvd
Saint Paul, MN 55130-2400

Mailing address

8170 33Rd Ave S
Ms 21110Q
Bloomington, MN 55425-4516

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20110830000753 MN Practitioner - Physical Medicine and Rehabilitation 1456521442 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Indiana University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Group Health IncGroup PAC ID 1759293954, 1,627 clinicians

Practice addresses (Care Compare)

295 Phalen Blvd
Saint Paul, MN 55130-2400
Phone (651) 495-6200

640 Jackson St
Saint Paul, MN 55101-2502
Phone (651) 221-3456

8325 Seasons Pkwy
Woodbury, MN 55125-4402
Phone (651) 702-5868

8450 Seasons Pkwy
Woodbury, MN 55125-4402
Phone (651) 702-5300

8600 Nicollet Ave
Bloomington, MN 55420-2824
Phone (952) 884-1148

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Group Health Plan Inc CurrentSince Aug 12, 2011 Accepting new patients
Group Health, Inc. Current Accepting new patients
Group Health, Inc. CurrentSince Aug 12, 2011 Accepting new patients
Regions Hospital Past Accepting new patients

Locations

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

295 Phalen Blvd
Saint Paul, MN 55130
Phone (651) 254-3200

640 Jackson St
#11102D
Saint Paul, MN 55101
Phone (651) 254-2032

Interoperability endpoints

  • Direct secure messaging: kmoench42343@direct.healthpartners.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 32

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1239580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733097600000",
    "number": "1861635435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S",
            "address_2": "MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "295 PHALEN BLVD",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551302400",
            "telephone_number": "651-495-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOENCH",
        "first_name": "KEITH",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-13",
        "last_updated": "2024-12-02",
        "certification_date": "2024-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MN",
            "license": "52609",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.