NPIMap

Individual provider Active NPI

Mary Moya, M.D.

  • Family Medicine Physician
  • Santa Rosa, CA
National Provider Identifier
1093844417
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A80185 Issued in CA
Practice address
751 Lombardi CT Ste B
Santa Rosa, CA 95407-6793
Phone
(707) 547-2222
Fax
(707) 547-2229
NPI assigned
Mar 2, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A80185 CA Primary

Addresses

Primary practice location

751 Lombardi CT Ste B
Santa Rosa, CA 95407-6793

Mailing address

751 Lombardi CT Ste B
Santa Rosa, CA 95407-6793
Phone (707) 547-2222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20070716000509 CA Practitioner - Family Practice 4688774953 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of California, San Diego School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1637 3Rd Ave
Suite B
Chula Vista, CA 91911-5823
Phone (619) 662-4100

4004 Beyer Blvd
San Ysidro, CA 92173-2007
Phone (619) 428-4463

4050 Beyer Blvd
San Ysidro, CA 92173-2007
Phone (619) 662-4100

678 3Rd Ave
Chula Vista, CA 91910-5736
Phone (619) 662-4100

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A80185CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centro de Salud de la Comunidad de San Ysidro, Inc. Current Accepting new patients
Centro de Salud de la Comunidad de San Ysidro, Inc CurrentSince Jun 1, 2007 Accepting new patients
Scripps Health Current Accepting new patients
Centro de Salud de la Comunidad de San Ysidro, Inc. Past Accepting new patients
Sharp Memorial Hospital Past Accepting new patients
Sharp Coronado Hospital and Healthcare Center Past Accepting new patients
Sharp Memorial Hospital Past Accepting new patients
Scripps Mercy Physicians Cardiology Medical Corporation Past Accepting new patients
Grossmont Hospital Corporation Past Accepting new patients
Sharp Chula Vista Medical Center Past Accepting new patients
Regents of the University of California Past Accepting new patients
Scripps Health Past Accepting new patients

Locations

678 Third Ave
Chula Vista, CA 91910

1601 Precision Park Ln
San Ysidro, CA 92173
Phone (619) 205-4585

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: mmoya18593@syhealth.direct-ci.com
  • Direct secure messaging: mmoya81367@scrippshlth.medalliesdirect.net

Organizations & group practices 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093844417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "751 LOMBARDI CT STE B",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954076793",
            "telephone_number": "707-547-2222",
            "fax_number": "707-547-2229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 LOMBARDI CT STE B",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954076793",
            "telephone_number": "707-547-2222",
            "fax_number": "707-547-2229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOYA",
        "first_name": "MARY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A80185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.