NPIMap

Organization Active NPI

Dan Moezzi MD PC

  • Primary Care Clinic/Center
  • Alamogordo, NM
National Provider Identifier
1962415364
Registry record updated Feb 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
95-302 Issued in NM
Legal business name
DAN MOEZZI MD PC
Practice address
2474 Indian Wells Rd
Alamogordo, NM 88310-3831
Phone
(575) 443-0339
Fax
(575) 434-5624
NPI assigned
Aug 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2010

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

Authorized official

Name
Dr. Dan H Moezzi, MDNPI 1275699357
Title
President
Phone
(575) 443-0339

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 95-302 NM Primary

Addresses

Primary practice location

2474 Indian Wells Rd
Alamogordo, NM 88310-3831

Mailing address

2474 Indian Wells Rd
Alamogordo, NM 88310-3831
Phone (575) 443-0339

Other identifiers 3

IdentifierTypeStateIssuer
H1455MedicaidNM
201017118OtherNMPRESBYTERIAN HEALTH CARE
NM004493OtherNMBLUE CROSS BLUE SHIELD

Other names 1

  • Indian Wells Family Practice Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070330000596 NM Part B Supplier - Clinic/Group Practice 6103920194 Receives reassigned benefits from 3 practitioners
Practice locations: Alamogordo, NM

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266710400000",
    "number": "1962415364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2474 INDIAN WELLS RD",
            "city": "ALAMOGORDO",
            "state": "NM",
            "postal_code": "883103831",
            "telephone_number": "575-443-0339",
            "fax_number": "575-434-5624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2474 INDIAN WELLS RD",
            "city": "ALAMOGORDO",
            "state": "NM",
            "postal_code": "883103831",
            "telephone_number": "575-443-0339",
            "fax_number": "575-434-5624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAN MOEZZI MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-15",
        "last_updated": "2010-02-21",
        "status": "A",
        "authorized_official_last_name": "MOEZZI",
        "authorized_official_first_name": "DAN",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "575-443-0339",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NM",
            "license": "95-302",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "H1455",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRESBYTERIAN HEALTH CARE",
            "identifier": "201017118",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "NM004493",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indian Wells Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Alamogordo, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.