Blue Moon of Colorado LLC
NPI 1629593967ActiveOrganization· Social Worker, Clinical· Plainfield, IL
Social Worker, Clinical in Plainfield, Illinois, registered in NPPES in August 2017. The authorized official on file is Melanie Donohue, Authorized Official. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1629593967 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Aug 8, 2017 |
| Last updated in NPPES | Sep 20, 2019 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Social Worker, Clinical Primary | 1041C0700X | — | — |
| Psychologist | 103T00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (CO) |
|---|
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