Individual provider Active NPI

Neikan Moghisaei

  • Physician Assistant
  • Buffalo, NY
National Provider Identifier
1104649862
Registry record updated Nov 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2001 Main St
Buffalo, NY 14208-1035
Phone
(716) 883-7000
NPI assigned
Nov 1, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

2001 Main St
Buffalo, NY 14208-1035

Mailing address

1901 Main Street Mailbox #1013
Buffalo, NY 14208
Phone (916) 792-2398

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251015003100 CA Practitioner - Physician Assistant 5991292724 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

11553 Marissa Way
Gold River, CA 95670-6229

PO Box
Los Angeles, CA 90088

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Integrated Pain Management Medical Group, Inc. CurrentSince Sep 29, 2025 Accepting new patients

Locations

650 University Ave
Ste 100
Sacramento, CA 95825
Phone (916) 333-5800

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1730419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730419200000",
    "number": "1104649862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 MAIN STREET MAILBOX #1013",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "14208",
            "telephone_number": "916-792-2398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 MAIN ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142081035",
            "telephone_number": "716-883-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOGHISAEI",
        "first_name": "NEIKAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-11-01",
        "last_updated": "2024-11-01",
        "certification_date": "2024-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.