NPIMap

Individual provider Active NPI

Bridgett R Moss, DO

  • Family Medicine Physician
  • Mequon, WI
National Provider Identifier
1043437213
Registry record updated Feb 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
50193 Issued in WI
Practice address
11430 N Port Washington Rd
Mequon, WI 53092-3414
Phone
(262) 518-1900
Fax
(262) 518-5052
NPI assigned
Apr 19, 2007
Last updated
Feb 10, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 50193 WI
Family Medicine Physician 207Q00000X 50193 WI Primary

Addresses

Primary practice location

11430 N Port Washington Rd
Mequon, WI 53092-3414

Mailing address

11430 N Port Washington Rd
Mequon, WI 53092-3414
Phone (262) 518-1900

Other identifiers 1

IdentifierTypeStateIssuer
50193OtherWISTATE MEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20070706000027 WI Practitioner - Family PracticePractitioner - Emergency Medicine 7113027087 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

W129N7055 Northfield Dr
Menomonee Falls, WI 53051-0538
Phone (262) 253-5400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
50193WIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Oct 26, 2019 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. Current Accepting new patients
The Medical College of Wisconsin, Inc. Emergency Medicine Current Accepting new patients
Froedtert & the Medical College of Wisconsin Community Physicians Inc. Past Accepting new patients
Prohealth Medical Group Inc Family Medicine Past Accepting new patients

Locations

W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060

W129N7055 Northfield Dr
Menomonee Falls, WI 53051
Phone (262) 251-5305

W180N8085 Town Hall Rd
Menomonee Fls, WI 53051
Phone (262) 257-5000

11430 N Port Washington Rd
Mequon, WI 53092
Phone (262) 518-1900

791 Summit Ave
Summit, WI 53066
Phone (262) 569-0251

1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990

201 N Mayfair Rd
Fl 2
Wauwatosa, WI 53226
Phone (414) 771-8228

Interoperability endpoints

  • Direct secure messaging: bmoss153127@direct.froedtert.com

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Martin Luther King Heritage Health CenterMilwaukee, WI, CCN 521829 Federally qualified health center Corporate Officer May 25, 2018
Isaac Coggs Heritage Health CenterMilwaukee, WI, CCN 521804 Federally qualified health center Corporate Officer May 25, 2018

Owned or controlled facilities with NPI records 7

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581292800000",
    "number": "1043437213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11430 N PORT WASHINGTON RD",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923414",
            "telephone_number": "262-518-1900",
            "fax_number": "262-518-5052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11430 N PORT WASHINGTON RD",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923414",
            "telephone_number": "262-518-1900",
            "fax_number": "262-518-5052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSS",
        "first_name": "BRIDGETT",
        "middle_name": "R",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-19",
        "last_updated": "2020-02-10",
        "certification_date": "2020-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "50193",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "50193",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "50193",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mequon, WI

Sources for this page

Verify at the official NPI Registry.