Individual provider Active NPI

Vanessa Vershel Moseley, NP

  • Family Nurse Practitioner
  • Waycross, GA
National Provider Identifier
1114351822
Registry record updated Aug 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN113050 Issued in GA
Practice address
2015 Alice St
Waycross, GA 31501-6209
Phone
(912) 283-2120
Fax
(912) 283-7321
NPI assigned
Aug 29, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 29, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN113050 GA Primary

Addresses

Primary practice location

2015 Alice St
Waycross, GA 31501-6209

Mailing address

2015 Alice St
Waycross, GA 31501-6209
Phone (912) 283-2120

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20131212000874 GA Practitioner - Nurse Practitioner 6507093820 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Internal Medicine of Southeast GeorgiaGroup PAC ID 2264532019, 4 clinicians

Practice addresses (Care Compare)

351 Peachtree St
Jesup, GA 31545-0245
Phone (912) 530-6582

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN113050GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Internal Medicine of Southeast Georgia CurrentSince May 3, 2016 Accepting new patients

Locations

351 Peachtree St
Jesup, GA 31545
Phone (912) 530-6582

228 Memorial Dr
Jesup, GA 31545
Phone (912) 530-6582

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JDDBDA
  • FHIR API: https://fhir4.healow.com/fhir/r4/JDDBDA/Endpoint/JDDBDA

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": "1377734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377734400000",
    "number": "1114351822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2015 ALICE ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315016209",
            "telephone_number": "912-283-2120",
            "fax_number": "912-283-7321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 ALICE ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315016209",
            "telephone_number": "912-283-2120",
            "fax_number": "912-283-7321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSELEY",
        "first_name": "VANESSA",
        "middle_name": "VERSHEL",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-08-29",
        "last_updated": "2013-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN113050",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waycross, GA

Sources for this page

Verify at the official NPI Registry.