Tina Ann Wilkinson Moore, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA03112 Issued in TX

Practice address

5700 E I 20 Service Rd S
Willow Park, TX 76008-5115

Phone

(817) 489-7300

Fax

(817) 489-7302

NPI assigned

Sep 15, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Physician Assistant

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Primary Health Physicians PLLCGroup PAC ID 7810237740, 240 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: tina.moore@hca7.eclinicaldirectplus.com

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.

• Primary Health Physicians, PLLC

  • Urgent Care Clinic/Center
  • Denton, TX
  • NPI 1770048704
  Medicare reassignment Care Compare group
• Dallas Medical Specialists, PLLC

  • Internal Medicine Physician
  • Dallas, TX
  • NPI 1508217811
  Medicare reassignment
• Icw Ta

  • Medical Physician Assistant
  • Wichita Falls, TX
  • NPI 1770660136
  NPD (past)

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

{
    "created_epoch": "1126742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548633600000",
    "number": "1124013198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5700 E I 20 SERVICE RD S",
            "city": "WILLOW PARK",
            "state": "TX",
            "postal_code": "760085115",
            "telephone_number": "817-737-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5700 E I 20 SERVICE RD S",
            "city": "WILLOW PARK",
            "state": "TX",
            "postal_code": "760085115",
            "telephone_number": "817-489-7300",
            "fax_number": "817-489-7302"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2400 Mall Cir",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "761161544",
            "country_code": "US",
            "telephone_number": "817-737-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILKINSON MOORE",
        "first_name": "TINA",
        "middle_name": "ANN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-15",
        "last_updated": "2019-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA03112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "196341501",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "196341502",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8F9743",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Mike White, O.D.
• Rachelle White, RBT
• Sydney Katherine White, BCBA
• Jessica Marie Wight, FNP-C
• Hannah Wilke, DC
• Jessica Danielle Williams, DO
• Willow Park Endoscopy Center, LLC
• Willow Park Home Health Care Services, Inc.
• Johnny M Wilson, M.D.
• Braden Alexander Wood

• Physician Assistant in Willow Park, TX
• Providers in Willow Park, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.