Active NPI
James Herman Moller, M.D.
- Pediatric Critical Care Medicine Physician
- Minneapolis, MN
National Provider Identifier
1891731907
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Critical Care Medicine Physician
- License
- 17125
- Practice address
- 420 Delaware St SE,
University of Minnesota Physicians MMC 94
Minneapolis, MN 55455 - Phone
- (612) 626-2755
- NPI assigned
- Jun 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 17125 | MN | |
| Pediatric Critical Care Medicine Physician | 2080P0203X | 17125 | MN | Primary |
| Pediatric Cardiology Physician | 2080P0202X | 17125 | MN |
Addresses
Primary practice location
420 Delaware St SE,
University of Minnesota Physicians MMC 94
Minneapolis, MN 55455
Mailing address
420 Delaware St SE
MMC 94 University of Minnesota Physicians
Minneapolis, MN 55455
Phone (612) 626-2755
Other identifiers 12
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1009248 | Other | PREFERRED ONE | |
| 25-00282 | Other | MEDICA PRIMARY | |
| 335772400 | Medicaid | MN | |
| A064 | Other | CHAMPUS/TRICARE | |
| 100924 | Other | UCARE | |
| 0047141 | Medicaid | MN | |
| 0251258 | Medicaid | OH | |
| 25-21110 | Other | MEDICA CHOICE | |
| 2T299MO | Other | MN | BCBS-MN |
| 0971549 | Medicaid | MN | |
| 604478 | Other | MN | ARAZ |
| HP21998 | Other | HEALTHPARTNERS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150761600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458259200000",
"number": "1891731907",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 DELAWARE ST SE",
"address_2": "MMC 94 UNIVERSITY OF MINNESOTA PHYSICIANS",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55455",
"telephone_number": "612-626-2755"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 DELAWARE ST SE,",
"address_2": "UNIVERSITY OF MINNESOTA PHYSICIANS MMC 94",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55455",
"telephone_number": "612-626-2755"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOLLER",
"first_name": "JAMES",
"middle_name": "HERMAN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-20",
"last_updated": "2016-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MN",
"license": "17125",
"primary": false
},
{
"code": "2080P0203X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Critical Care Medicine",
"state": "MN",
"license": "17125",
"primary": true
},
{
"code": "2080P0202X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Cardiology",
"state": "MN",
"license": "17125",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "1009248",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA PRIMARY",
"identifier": "25-00282",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "335772400",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS/TRICARE",
"identifier": "A064",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "100924",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0047141",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0251258",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA CHOICE",
"identifier": "25-21110",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS-MN",
"identifier": "2T299MO",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0971549",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ARAZ",
"identifier": "604478",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "HP21998",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.