Active NPI
Michael Arthur Moss
- Clinical Psychologist
- Fountain Hill, PA
National Provider Identifier
1053358184
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PS007161L
- Practice address
- 724 Delaware Ave
Fountain Hill, PA 18015-1108 - Phone
- (800) 257-8715
- Fax
- (800) 819-1655
- NPI assigned
- May 31, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PS007161L | PA | Primary |
Addresses
Primary practice location
724 Delaware Ave
Fountain Hill, PA 18015-1108
Mailing address
5 Oberlin Ave
Swarthmore, PA 19081-1626
Phone (610) 544-8679
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6100543 | Other | EVERCARE | |
| 0015352780008 | Medicaid | PA | |
| 680013328 | Other | RAIL ROAD | |
| 749181 | Other | PA | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS007161L | PA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MHSP,Inc | Clinical | Past | Accepting new patients |
Organizations & group practices 1
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.
-
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- Brooklyn, NY
- NPI 1023049723
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1221436800000",
"number": "1053358184",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 OBERLIN AVE",
"city": "SWARTHMORE",
"state": "PA",
"postal_code": "190811626",
"telephone_number": "610-544-8679"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "724 DELAWARE AVE",
"city": "FOUNTAIN HILL",
"state": "PA",
"postal_code": "180151108",
"telephone_number": "800-257-8715",
"fax_number": "800-819-1655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOSS",
"first_name": "MICHAEL",
"middle_name": "ARTHUR",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-31",
"last_updated": "2008-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PA",
"license": "PS007161L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EVERCARE",
"identifier": "6100543",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0015352780008",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAIL ROAD",
"identifier": "680013328",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "749181",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fountain Hill, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.