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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

JACKSON T MORAN
NPI 1104574680
Emergency Medicine in Waconia, MN

Active since March 14, 2022PECOS Enrolled
500 S MAPLE ST, WACONIA, MN 55387(952) 777-5553 Get Directions Write a Review

NPPES record last updated: September 24, 2026. Verified against the NPPES registry weekly; last sync: October 04, 2026.

Record update history: Sep 24, 2026, Apr 7, 2023 (2 updates tracked since 2023).

About Jackson T Moran NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACKSON T MORAN (NPI 1104574680) is an individual emergency medicine provider in Waconia, Minnesota, licensed in Minnesota (82147) and active in the NPI registry since March 2022. He is enrolled in Medicare PECOS and is a graduate of University Of Chicago, Pritzker School Of Medicine (2023).

NPPES Registry Identity

NPI1104574680
Entity TypeIndividualMale
Primary Taxonomy207P00000X
Provider Legal NameJACKSON T MORAN
Location Address500 S MAPLE STWaconia, MN 55387-1791
Mailing Address500 S Maple StWaconia, MN 55387-1791 · (952) 777-5553
Phone(952) 777-5553
Sole ProprietorNo
Medical School CMSUniversity Of Chicago, Pritzker School Of MedicineGraduated 2023
Enumeration DateMarch 14, 2022
Last NPPES UpdateSeptember 24, 20262 updates tracked since enumeration
NPPES CertifiedSeptember 24, 2026
✔ NPI 1104574680 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyEmergency MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207P00000X
License✔ Licensed in MN · 82147
Definition
An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.
500 S MAPLE ST, Waconia, MN 55387
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jackson T Moran is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID2264890904
PECOS Enrollment IDI20260610000830
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55387 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$85.82 typical visit price
range $56.00 – $168.28
Typical copayment $21.45 (range $14.00 – $42.07)
Most-billed visit code 99203
Established Patient
$98.61 typical visit price
range $18.32 – $138.04
Typical copayment $24.65 (range $4.58 – $34.51)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. JEFFREY DUANE MARTIN CRNA
Nurse Anesthetist, Certified Registered
500 S MAPLE ST
WACONIA, MN 55387
Carver County (952) 442-2191
RIDGEVIEW MEDICAL CENTER
Non-Pharmacy Dispensing Site
500 S MAPLE ST
WACONIA, MN 55387
Carver County (952) 653-2528
SARA MAURER CNP
Nurse Practitioner (Adult Health)
500 S MAPLE ST
WACONIA, MN 55387
Carver County (952) 442-2191
DR. BRUCE HUBBARD M.D.
Emergency Medicine
500 S MAPLE ST
WACONIA, MN 55387
Carver County (952) 442-2191
CYNTHIA MOHNEN BRICK CRNA
Nurse Anesthetist, Certified Registered
500 S MAPLE ST
WACONIA, MN 55387
Carver County (952) 442-2191
ANDREW TYLER MILLER MD
Radiology (Diagnostic Radiology)
500 S MAPLE ST
WACONIA, MN 55387
Carver County (952) 442-2191
MARY K. JORDAN LICSW
Social Worker
500 S MAPLE ST
WACONIA, MN 55387
Carver County (952) 442-2191
RIDGEVIEW ANESTHESIA ASSOC, P.A.
Anesthesiology
500 S MAPLE ST
WACONIA, MN 55387
Carver County (952) 442-2191

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jackson Moran's NPI number?

The NPI number for Jackson Moran is 1104574680. It was assigned to this individual provider in the NPPES registry on March 14, 2022.

Where is Jackson Moran located?

Jackson Moran practices at 500 S Maple St, Waconia, MN 55387. The listed phone number is (952) 777-5553.

What is Jackson Moran's specialty?

The primary specialty registered for this NPI is Emergency Medicine with taxonomy code 207P00000X.

Is Jackson Moran enrolled in Medicare?

Yes. Jackson Moran is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jackson Moran was last updated on September 24, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.