EDWARD BRIDGES MOODY (NPI# 1275652653) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275652653 |
| Entity Type | Individual |
| Full Name | EDWARD BRIDGES MOODY |
| Credential | M.D. |
| Practice Address |
100 Ne Randolph Ave St. Francis Occupational Health Peoria IL 61606-1919 |
| Practice Telephone | 3096248525 |
| Mailing Telephone | 3096248525 |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2083P0500X |
Preventive Medicine Specialization: Preventive Medicine/Occupational Environmental Medicine |
IL | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982808911 | Edward E. Moody Jr. | Counselor | 101 Bradborne Cir, Clayton, NC 27527-4508 | 2007-06-13 |
| 1861557407 | Edward Morris Moody II | Dentist | 404 E Texas Ave, Rayne, LA 70578-6435 | 2006-12-26 |
| 1669920591 | Edward Morris Moody IIi | Dentist | 404 E Texas Ave, Rayne, LA 70578-6435 | 2016-09-20 |
| 1396769006 | Edward Herbert Moody Jr. | Dentist | 920 W Main St, Morristown, TN 37814-4515 | 2006-07-26 |
| Street Address |
100 NE RANDOLPH AVE ST. FRANCIS OCCUPATIONAL HEALTH |
| City | PEORIA |
| State | IL |
| Zip Code | 61606-1919 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942220819 | Carrie A. Randell | Physical Therapist | 100 Ne Randolph Ave, Peoria, IL 61606-1919 | 2006-07-20 |
| 1497271035 | Ashley Nicole Workman | Nurse Practitioner | 100 Ne Randolph Ave, Peoria, IL 61606-1919 | 2017-08-15 |
| 1922544287 | Michael Holloway | Physical Therapist | 100 Ne Randolph Ave, Peoria, IL 61606-1919 | 2017-01-11 |
| 1710423033 | Lauren Raube | Physical Therapist | 100 Ne Randolph Ave, Peoria, IL 61606-1919 | 2017-01-10 |
| 1316482912 | Meredith Burd | Occupational Therapist | 100 Ne Randolph Ave, Peoria, IL 61606-1919 | 2017-01-05 |
| 1942745120 | Brittany Heidemann | Speech-Language Pathologist | 100 Ne Randolph Ave, Peoria, IL 61606-1919 | 2016-12-27 |
| 1518419233 | Pamela Madden | Nurse Practitioner | 100 Ne Randolph Ave, Peoria, IL 61606-1919 | 2016-10-28 |
| 1063885556 | Jenny Wagner | Nurse Practitioner | 100 Ne Randolph Ave, Peoria, IL 61606-1919 | 2015-11-05 |
| 1164813515 | Connie E. Zurski | Nurse Practitioner | 100 Ne Randolph Ave, Peoria, IL 61606-1919 | 2015-02-06 |
| 1932505302 | Sally N. Coyle | Nurse Practitioner | 100 Ne Randolph Ave, Peoria, IL 61606-1919 | 2014-11-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194292334 | Kelley Stork | Speech-Language Pathologist | 807 W Columbia Terrace, Peoria, IL 61606 | 2018-10-25 |
| 1689140519 | Emma Cristine Tully | Speech-Language Pathologist | 1619 W. Fredonia Ave, Peoria, IL 61606 | 2018-10-18 |
| 1316492432 | Jennifer Greenwood | Nurse Practitioner | 1001 Main St Ste 500a, Peoria, IL 61606 | 2016-08-18 |
| 1104944974 | Robert I Martin | Preventive Medicine | 1127 N North Street, Peoria, IL 61606 | 2007-03-27 |
| 1023062312 | Saint Francis Medical Center | Physical Medicine & Rehabilitation | 100 Ne Randoph Street, Peoria, IL 61606 | 2006-05-20 |
| 1174573307 | Cpo Services, Inc | Prosthetic/Orthotic Supplier | 741 West Main Street, Peoria, IL 61606 | 2006-05-10 |
| 1174025357 | Amy M Durst | Nurse Practitioner | 1001 Main St Ste 500a, Peoria, IL 61606 | 2018-03-05 |
| 1538471099 | Jacob Royle Hopping | Surgery | 1001 Main St Ste 300, Peoria, IL 61606 | 2010-07-12 |
| 1881906410 | Heather Jefford | Clinical Nurse Specialist | 1001 Main St, 3rd Floor, Peoria, IL 61606 | 2010-07-12 |
| 1306874128 | David L Crawford | Surgery | 1001 Main Street, Suite 300, Peoria, IL 61606 | 2006-06-29 |
| Find all providers in zip 61606 | ||||
| Taxonomy Code | 2083P0500X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Preventive Medicine |
| Specialization | Preventive Medicine/Occupational Environmental Medicine |
| A preventive medicine physician who specializes in preventive medicine/occupational-environmental medicine, which is focused on protecting the population from occupational and environmental conditions. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Preventive Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376673673 | John C Ruthman | Preventive Medicine | 100 Ne Adams St, Peoria, IL 61637-0001 | 2007-03-06 |
| 1275670242 | Keith David Mosienko | Preventive Medicine | 6865 W Briles Rd, Peoria, AZ 85383-7015 | 2007-01-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568860500 | Healthstat On-site Clinic Watlow Richmond Il | Preventive Medicine | 5710 Kenosha St, Richmond, IL 60071-9411 | 2014-12-08 |
| 1164854402 | Healthstat On-site Clinic/parker Hannifin Rockford | Preventive Medicine | 10711 N 2nd St, Machesney Park, IL 61115-1459 | 2013-08-08 |
| 1114299476 | Martin W Harrison | Preventive Medicine | 1318 W Catalpa Ave, Chicago, IL 60640-1317 | 2012-02-02 |
| 1851660583 | Healthstat Inc | Preventive Medicine | 2700 Ellis Rd, Joliet, IL 60433-8459 | 2011-12-27 |
| 1568756831 | William Leslie Rutherford Jr. | Preventive Medicine | 9660 Wolf Rd, Box 42, Geneseo, IL 61254-9039 | 2011-06-04 |
| 1437451374 | Maria Rosa | Preventive Medicine | 2133 W Lexington St, Chicago, IL 60612-3707 | 2010-11-29 |
| 1437464112 | Leena H.a.h Almarzouqi | Preventive Medicine | 114 E Cook Ave, Libertyville, IL 60048-2015 | 2010-08-18 |
| 1598995870 | Shari Beth Glynn | Preventive Medicine | 100 Abbott Park Road, C/o Abbott Laboratories: Ap6d/dept. 058p, Abbott Park, IL 60064-6035 | 2009-07-21 |
| 1578786117 | John K Parker | Preventive Medicine | Veeder Health Center, 20th and Iowa, Granite City, IL 62040 | 2007-04-11 |
| 1063539674 | James Robert Desalvio | Preventive Medicine | 810 W. Anthony Dr., Urbana, IL 61802-7431 | 2007-03-26 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.