Active NPI
Jeffrey Mark Moseman, M.D.
- Family Medicine Physician
- Bloomington, IN
National Provider Identifier
1962542456
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 01031093
- Practice address
- 600 N Jordan Ave
Bloomington, IN 47405-3190 - Phone
- (812) 855-1625
- Fax
- (812) 855-4628
- NPI assigned
- Feb 7, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 01031093 | IN | Primary |
Addresses
Primary practice location
600 N Jordan Ave
Bloomington, IN 47405-3190
Mailing address
1800 E 2ND St
Bloomington, IN 47401-5224
Phone (812) 331-7717
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01031093 | IN | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1962542456",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 E 2ND ST",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474015224",
"telephone_number": "812-331-7717"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 N JORDAN AVE",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474053190",
"telephone_number": "812-855-1625",
"fax_number": "812-855-4628"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOSEMAN",
"first_name": "JEFFREY",
"middle_name": "MARK",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IN",
"license": "01031093",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.