Individual provider Active NPI

Rachael Moyer, FNP

  • Family Nurse Practitioner
  • Goshen, IN
National Provider Identifier
1972084317
Registry record updated Apr 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71008346A Issued in IN
Practice address
2222 Rieth Blvd Suite 100
Goshen, IN 46526-5869
Phone
(574) 875-1200
NPI assigned
Aug 23, 2018
Last updated
Apr 29, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 71008346A IN Primary

Addresses

Primary practice location

2222 Rieth Blvd Suite 100
Goshen, IN 46526-5869

Mailing address

18094 County Road 40
Goshen, IN 46526-6992
Phone (574) 312-8889

Other practice location 1

1815 E Ireland Rd
South Bend, IN 46614-2845
Phone (574) 647-1750

Other practice location 2

6913 N Main St
Granger, IN 46530-8039
Phone (574) 647-1550

Other practice location 3

3301 County Road 6 E
Elkhart, IN 46514-7673
Phone (574) 266-5342

Other identifiers 1

IdentifierTypeStateIssuer
300021570MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
71008346AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cleanslate Medical Group of Indiana LLC CurrentSince Nov 1, 2023 Accepting new patients
Villagemd Indiana, PC CurrentSince Jan 4, 2022 Accepting new patients

Locations

4925 S Scatterfield Rd
Anderson, IN 46013
Phone (765) 442-0402

1004 Parkway Ave
Ste E
Elkhart, IN 46516
Phone (574) 218-7131

429 W Pike St
Goshen, IN 46526
Phone (574) 534-7616

6097 Broadway
Merrillville, IN 46410
Phone (219) 758-5152

Interoperability endpoints

  • Direct secure messaging: rachael.moyer.1@14940.direct.athenahealth.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1534982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682726400000",
    "number": "1972084317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18094 COUNTY ROAD 40",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465266992",
            "telephone_number": "574-312-8889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 RIETH BLVD SUITE 100",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465265869",
            "telephone_number": "574-875-1200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1815 E Ireland Rd",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466142845",
            "country_code": "US",
            "telephone_number": "574-647-1750",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6913 N Main St",
            "address_purpose": "LOCATION",
            "city": "Granger",
            "state": "IN",
            "postal_code": "465308039",
            "country_code": "US",
            "telephone_number": "574-647-1550",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3301 County Road 6 E",
            "address_purpose": "LOCATION",
            "city": "Elkhart",
            "state": "IN",
            "postal_code": "465147673",
            "country_code": "US",
            "telephone_number": "574-266-5342",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOYER",
        "first_name": "RACHAEL",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-23",
        "last_updated": "2023-04-29",
        "certification_date": "2023-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71008346A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300021570",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Goshen, IN

Sources for this page

Verify at the official NPI Registry.