Individual provider Active NPI

Stephanie Kay Moore, CRNA

  • Certified Registered Nurse Anesthetist
  • Moses Lake, WA
National Provider Identifier
1093050916
Registry record updated Feb 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
AP60334148 Issued in WA
Practice address
801 E Wheeler Rd
Moses Lake, WA 98837-1820
Phone
(509) 765-5606
NPI assigned
Dec 4, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 11, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X AP60334148 WA Primary

Addresses

Primary practice location

801 E Wheeler Rd
Moses Lake, WA 98837-1820

Mailing address

2655 Northwinds Pkwy
Alpharetta, GA 30009-2280
Phone (770) 643-5619

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130312000341 WA Practitioner - Certified Registered Nurse Anesthetist (Crna) 0749435071 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1550 S Pioneer Way
Moses Lake, WA 98837-4613
Phone (509) 793-9780

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Grant County Public Hospital District 1 CurrentSince Jan 1, 2014 Accepting new patients
Grant County Public Hospital District 1 CurrentSince Jan 1, 2014 Accepting new patients
Grant County Public Hospital District 1 Current Accepting new patients
Premier Anesthesia of Richland a Division of Premier Anesthesia, LLC Nurse Anesthetist, Certified Registered CurrentSince Feb 4, 2013 Accepting new patients

Locations

2655 Northwinds Pkwy
Alpharetta, GA 30009
Phone (678) 690-7804

1550 S Pioneer Way
Moses Lake, WA 98837
Phone (509) 793-9780

801 E Wheeler Rd
Moses Lake, WA 98837
Phone (509) 765-5606

2000 S Clover Dr
Moses Lake, WA 98837
Phone (509) 765-5606

660 S Coolidge St
Moses Lake, WA 98837

888 Swift Blvd
Richland, WA 99352
Phone (509) 942-2115

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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": "1354579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360540800000",
    "number": "1093050916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2655 NORTHWINDS PKWY",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300092280",
            "telephone_number": "770-643-5619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 E WHEELER RD",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988371820",
            "telephone_number": "509-765-5606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "STEPHANIE",
        "middle_name": "KAY",
        "name_prefix": "Ms.",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-12-04",
        "last_updated": "2013-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WA",
            "license": "AP60334148",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moses Lake, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.