NPIMap

Individual provider Active NPI

Jeffrey Alden Moberg Jr., PA-C

  • Physician Assistant
  • Tioga, ND
National Provider Identifier
1235490269
Registry record updated Jun 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PAC0486
Practice address
810 N Welo St
Tioga, ND 58852-7157
Phone
(701) 664-3305
NPI assigned
Jun 6, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 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 PAC0486 Primary

Addresses

Primary practice location

810 N Welo St
Tioga, ND 58852-7157

Mailing address

810 N Welo St
Tioga, ND 58852-7157
Phone (701) 664-3305

Other practice location 1

615 6th St SE
Stanley, ND 58784-4444
Phone (701) 628-2424

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
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
I20120824000463 ND Practitioner - Physician Assistant 1355598475 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of North Dakota School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountrail County Medical Center IncGroup PAC ID 9739088931, 12 clinicians
Tioga Medical CenterGroup PAC ID 1254390305, shared by 7 NPIs, 10 clinicians

Practice addresses (Care Compare)

615 6TH St SE
Stanley, ND 58784-4444
Phone (701) 628-2505

810 N Welo St
Tioga, ND 58852-7157
Phone (701) 664-3305

Hospital & facility affiliations

  • Tioga Medical Center Hospital, Tioga, ND, CCN 351300
  • Mountrail County Medical Center Inc Hospital, Stanley, ND, CCN 351301
  • Trinity Hospitals Hospital, Minot, ND, CCN 350006
  • CHI St Alexius Health Hospital, Bismarck, ND, CCN 350002
  • Tioga Medical Center Nursing home, CCN 35Z300

Merit-based Incentive Payment System (MIPS)

Final score
89.32 of 100Reported as apm
Quality
71.89
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Tioga Medical Center CurrentSince Jun 23, 2012 Accepting new patients
Mountrail County Medical Center, Inc. CurrentSince Nov 14, 2012 Accepting new patients
Tioga Medical Center CurrentSince Nov 30, 2025 Accepting new patients
Tioga Medical Center CurrentSince Sep 1, 2015 Accepting new patients
St Luke'S Hospital CurrentSince Oct 21, 2022 Accepting new patients
Tioga Medical Center Past Accepting new patients

Organizations & group practices 8

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 10

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": "1338940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717459200000",
    "number": "1235490269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 N WELO ST",
            "city": "TIOGA",
            "state": "ND",
            "postal_code": "588527157",
            "telephone_number": "701-664-3305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 N WELO ST",
            "city": "TIOGA",
            "state": "ND",
            "postal_code": "588527157",
            "telephone_number": "701-664-3305"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "615 6th St SE",
            "address_purpose": "LOCATION",
            "city": "Stanley",
            "state": "ND",
            "postal_code": "587844444",
            "country_code": "US",
            "telephone_number": "701-628-2424",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOBERG",
        "first_name": "JEFFREY",
        "middle_name": "ALDEN",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-06",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": "PAC0486",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tioga, ND

Sources for this page

Verify at the official NPI Registry.