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JACKSON T MORAN
NPI 1104574680
Student in an Organized Health Care Education/Training Program in Minneapolis, MN

Active since March 14, 2022PECOS Enrolled
701 PARK AVE, MINNEAPOLIS, MN 55415(612) 873-3000 Get Directions Write a Review

NPPES record last updated: April 7, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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 student in an organized health care education/training program in Minneapolis, Minnesota 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 Taxonomy390200000X
Provider Legal NameJACKSON T MORAN
Location Address701 PARK AVEMinneapolis, MN 55415-1623
Mailing Address701 Park AveMinneapolis, MN 55415-1623 · (612) 873-3000
Phone(612) 873-3000
Sole ProprietorNo
Medical School CMSUniversity Of Chicago, Pritzker School Of MedicineGraduated 2023
Enumeration DateMarch 14, 2022
Last NPPES UpdateApril 7, 2023
NPPES CertifiedApril 7, 2023
✔ NPI 1104574680 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
701 PARK AVE, Minneapolis, MN 55415
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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.

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.

DR. MICHAEL CHARLES HARLOW MD
Psychiatry & Neurology (Psychiatry)
701 PARK AVE
MINNEAPOLIS, MN 55415
Hennepin County (612) 873-3000
DANIEL HART
Emergency Medicine
701 PARK AVE
MINNEAPOLIS, MN 55415
Hennepin County (612) 873-3000
GEORGE NOESEN
Dentist (Oral and Maxillofacial Surgery)
701 PARK AVE
MINNEAPOLIS, MN 55415
Hennepin County (612) 873-3000
MRS. CARMODY ALICE SIME LPCC, LADC
Counselor (Professional)
701 PARK AVE
MINNEAPOLIS, MN 55415
Hennepin County (612) 432-2008
MR. JUSTIN GREGORY SCHULZ MD
Student in an Organized Health Care Education/Training Program
701 PARK AVE
MINNEAPOLIS, MN 55415
Hennepin County (612) 873-3000
EVAN SMITH
Emergency Medicine
701 PARK AVE
MINNEAPOLIS, MN 55415
Hennepin County (612) 873-3000
ALEXA M LYON MD
Student in an Organized Health Care Education/Training Program
701 PARK AVE
MINNEAPOLIS, MN 55415
Hennepin County (612) 873-3000
SUMEDHA REDDY BANDI DO
Student in an Organized Health Care Education/Training Program
701 PARK AVE
MINNEAPOLIS, MN 55415
Hennepin County (612) 873-3000

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 701 Park Ave, Minneapolis, MN 55415. The listed phone number is (612) 873-3000.

What is Jackson Moran's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

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 April 7, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years 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.