NPIMap

Individual provider Active NPI

Ty Alexander Moody, MD

  • Internal Medicine Physician
  • Mitchell, SD
National Provider Identifier
1932787017
Registry record updated May 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0604 Issued in SD
Practice address
1900 Grassland Dr
Mitchell, SD 57301-6335
Phone
(605) 995-7000
NPI assigned
Mar 31, 2021
Last updated
May 2, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 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
Internal Medicine Physician 207R00000X 0604 SD Primary

Addresses

Primary practice location

1900 Grassland Dr
Mitchell, SD 57301-6335

Mailing address

1900 Grassland Dr
Mitchell, SD 57301-6335
Phone (605) 630-9377

Other practice location 1

1400 W 22nd St
Sioux Falls, SD 57105-1554
Phone (605) 357-1410

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
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
I20240914000393 SD Practitioner - Internal Medicine 5890235089 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rural Health Care IncGroup PAC ID 3476447541, 156 clinicians
Avera Queen of PeaceGroup PAC ID 9335050806, 122 clinicians

Practice addresses (Care Compare)

1900 Grassland Dr
Suite 103
Mitchell, SD 57301-6386
Phone (605) 995-7000

525 N Foster St
Mitchell, SD 57301-2966
Phone (605) 995-2234

609 Garfield Ave
Murdo, SD 57559-4100
Phone (605) 669-2121

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0604SDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Avera Queen of Peace Current Accepting new patients
Avera Queen of Peace CurrentSince Aug 1, 2024 Accepting new patients
Rural Health Care, Inc CurrentSince Aug 1, 2024 Accepting new patients
Avera Queen of Peace Internal Medicine CurrentSince Aug 1, 2024 Accepting new patients
Rural Health Care, Inc. Current Accepting new patients
Rural Health Care, Inc CurrentSince Aug 1, 2024 Accepting new patients

Locations

1900 Grassland Dr
Mitchell, SD 57301
Phone (605) 655-1220

525 N Foster St
Mitchell, SD 57301
Phone (605) 995-2000

Organizations & group practices 6

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 33

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

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1617148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714608000000",
    "number": "1932787017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 GRASSLAND DR",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573016335",
            "telephone_number": "605-630-9377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 GRASSLAND DR",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573016335",
            "telephone_number": "605-995-7000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 W 22nd St",
            "address_purpose": "LOCATION",
            "city": "Sioux Falls",
            "state": "SD",
            "postal_code": "571051554",
            "country_code": "US",
            "telephone_number": "605-357-1410",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOODY",
        "first_name": "TY",
        "middle_name": "ALEXANDER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-31",
        "last_updated": "2024-05-02",
        "certification_date": "2024-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SD",
            "license": "0604",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mitchell, SD

Sources for this page

Verify at the official NPI Registry.