Active NPI
Moulton Group PC
- Specialist
- Monroe, MI
National Provider Identifier
1053395798
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 4301042774
- Legal business name
- MOULTON GROUP PC
- Practice address
- 2246 N Monroe St
Monroe, MI 48162-4254 - Phone
- (734) 241-4950
- Fax
- (734) 243-4269
- NPI assigned
- Dec 6, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Paulette Patricia Moulton, M.D.
- Title
- Owner
- Phone
- (734) 241-4950
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 4301042774 | MI | Primary |
Addresses
Primary practice location
2246 N Monroe St
Monroe, MI 48162-4254
Mailing address
PO Box 2503
Monroe, MI 48161-7503
Phone (734) 241-4950
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4893843 | Medicaid | MI | |
| 0705810691 | Other | MI | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133827200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1053395798",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2503",
"city": "MONROE",
"state": "MI",
"postal_code": "481617503",
"telephone_number": "734-241-4950",
"fax_number": "734-243-4269"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2246 N MONROE ST",
"city": "MONROE",
"state": "MI",
"postal_code": "481624254",
"telephone_number": "734-241-4950",
"fax_number": "734-243-4269"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MOULTON GROUP PC",
"organizational_subpart": "NO",
"enumeration_date": "2005-12-06",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "MOULTON",
"authorized_official_first_name": "PAULETTE",
"authorized_official_middle_name": "PATRICIA",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "734-241-4950",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist",
"state": "MI",
"license": "4301042774",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4893843",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "0705810691",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Monroe, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.