NPIMap

Individual provider Active NPI

Danna Mavis Constance Moisii, PA-C

  • Medical Physician Assistant
  • Soldotna, AK
National Provider Identifier
1003318585
Registry record updated Jul 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
171496 Issued in AK
Practice address
35670 Kenai Spur Hwy Ste 102
Soldotna, AK 99669-7649
Phone
(907) 921-2221
Fax
(907) 921-2201
NPI assigned
Mar 1, 2018
Last updated
Jul 12, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 6949 AZ
Medical Physician Assistant 363AM0700X PA11692 TX
Medical Physician Assistant 363AM0700X 171496 AK Primary

Addresses

Primary practice location

35670 Kenai Spur Hwy Ste 102
Soldotna, AK 99669-7649

Mailing address

34603 Sharky Ave
Soldotna, AK 99669-8871
Phone (907) 921-2221

Other identifiers 1

IdentifierTypeStateIssuer
168676165OtherPRACTICE NPI NUMBER

Other names 1

  • Danna Mavis Constance Foust Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210408002782 AK Practitioner - Physician Assistant 5597005926 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

35670 Kenai Spur Hwy
Suite 102
Soldotna, AK 99669-7649
Phone (907) 921-2221

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
6949AZMDGeneral Practice Dentistry
PA11692TXMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ravencrest Medical LLC Current Accepting new patients
Odyssey Urgent Care and Occupational Health CurrentSince Jan 14, 2024 Accepting new patients

Locations

11595 Kenai Spur Hwy
Kenai, AK 99611
Phone (907) 313-4569

35670 Kenai Spur Hwy
Ste 102
Soldotna, AK 99669
Phone (907) 260-3668

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IDCEDD
  • FHIR API: https://fhir4.healow.com/fhir/r4/IDCEDD/Endpoint/IDCEDD

Organizations & group practices 3

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.

Hospital & facility affiliations 20

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1519862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720742400000",
    "number": "1003318585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34603 SHARKY AVE",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "996698871",
            "telephone_number": "907-921-2221",
            "fax_number": "907-921-2201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35670 KENAI SPUR HWY STE 102",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "996697649",
            "telephone_number": "907-921-2221",
            "fax_number": "907-921-2201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOISII",
        "first_name": "DANNA",
        "middle_name": "MAVIS CONSTANCE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-01",
        "last_updated": "2024-07-12",
        "certification_date": "2024-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "6949",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA11692",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AK",
            "license": "171496",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRACTICE NPI NUMBER",
            "identifier": "168676165",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DANNA",
            "last_name": "FOUST",
            "middle_name": "MAVIS CONSTANCE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Soldotna, AK

Sources for this page

Verify at the official NPI Registry.