Active NPI
Zohra F Moeenuddin, M.D.
- Pediatrics Physician
- Peoria, IL
National Provider Identifier
1922043223
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 01061030A
- Practice address
- 320 E Armstrong Ave
Peoria, IL 61603-3172 - Phone
- (309) 624-9690
- Fax
- (309) 624-9714
- NPI assigned
- Jun 19, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 01061030A | IN | Primary |
Addresses
Primary practice location
320 E Armstrong Ave
Peoria, IL 61603-3172
Mailing address
320 E Armstrong Ave
Peoria, IL 61603-3172
Phone (309) 680-7600
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 809840 | Other | IL | MEDICARE GROUP PTAN |
| 01061030B | Other | IN | CSR |
| 200533760 | Medicaid | IN | |
| 036113542 | Medicaid | IL | |
| 11520388 | Other | CAQH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151125000911 | IL | Order and Referring Only - Pediatric Medicine | 2668522269 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01061030A | IN | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150675200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1922043223",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "320 E ARMSTRONG AVE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616033172",
"telephone_number": "309-680-7600",
"fax_number": "309-495-8614"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "320 E ARMSTRONG AVE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616033172",
"telephone_number": "309-624-9690",
"fax_number": "309-624-9714"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOEENUDDIN",
"first_name": "ZOHRA",
"middle_name": "F",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-06-19",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IN",
"license": "01061030A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP PTAN",
"identifier": "809840",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CSR",
"identifier": "01061030B",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200533760",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036113542",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "11520388",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.