Individual provider Active NPI

Shayna Nitin Mooney, MD

  • Internal Medicine Physician
  • Olympia, WA
National Provider Identifier
1164982245
Registry record updated Sep 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD61283138 Issued in WA
Practice address
413 Lilly Rd NE
Olympia, WA 98506-5133
Phone
(360) 493-4083
Fax
(360) 486-6436
NPI assigned
Mar 23, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X MD61283138 WA
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X MD61283138 WA Primary

Addresses

Primary practice location

413 Lilly Rd NE
Olympia, WA 98506-5133

Mailing address

PO Box 3360
Portland, OR 97208-3360

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220927002629 WA Practitioner - Internal MedicinePractitioner - Hospitalist 9739414848 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Hospitalist
Education
Brody School of Medicine at East Carolina University, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

413 Lilly Rd NE
Olympia, WA 98506-5133
Phone (360) 493-4083

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD61283138WAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Washington CurrentSince Aug 29, 2022 Accepting new patients
Providence Health & Services Washington Internal Medicine Current Accepting new patients
Providence Health & Services Washington CurrentSince Aug 29, 2022 Accepting new patients
Providence Health & Services Washington CurrentSince Aug 29, 2022 Accepting new patients
Providence Health & Services Washington CurrentSince Aug 29, 2022 Accepting new patients
Providence Health & Services Washington Past Accepting new patients

Locations

914 S Scheuber Rd
Centralia, WA 98531
Phone (360) 330-8516

413 Lilly Rd NE
Olympia, WA 98506
Phone (360) 491-9480

525 Lilly Rd NE
Olympia, WA 98506
Phone (360) 413-8550

Organizations & group practices 6

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 2

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": "1553299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663027200000",
    "number": "1164982245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3360",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 LILLY RD NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065133",
            "telephone_number": "360-493-4083",
            "fax_number": "360-486-6436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOONEY",
        "first_name": "SHAYNA",
        "middle_name": "NITIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-23",
        "last_updated": "2022-09-13",
        "certification_date": "2022-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "WA",
            "license": "MD61283138",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD61283138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia, WA

Sources for this page

Verify at the official NPI Registry.