Active NPI
Jerry Ray Moody, MS, RD, CNSD
- Registered Dietitian
- Saint Louis, MO
National Provider Identifier
1902033087
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- D-593
- Practice address
- 12647 Olive Blvd Ste 600
Saint Louis, MO 63141-6346 - Phone
- (800) 325-3982
- NPI assigned
- Jun 16, 2009
- Last updated
- Jun 16, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | D-593 | ID | Primary |
Addresses
Primary practice location
12647 Olive Blvd Ste 600
Saint Louis, MO 63141-6346
Mailing address
4008 Nordland TRL
Castle Rock, CO 80109-7937
Phone (303) 814-1511
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)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D-593 | ID | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245110400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1245110400000",
"number": "1902033087",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4008 NORDLAND TRL",
"city": "CASTLE ROCK",
"state": "CO",
"postal_code": "801097937",
"telephone_number": "303-814-1511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12647 OLIVE BLVD STE 600",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631416346",
"telephone_number": "800-325-3982"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOODY",
"first_name": "JERRY",
"middle_name": "RAY",
"name_prefix": "Mr.",
"credential": "MS, RD, CNSD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-06-16",
"last_updated": "2009-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "ID",
"license": "D-593",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.