Tina Marie Moussally, MSPA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA17710 Issued in CA

Practice address

6501 Truxtun Ave
Bakersfield, CA 93309-0633

Phone

(661) 322-2206

NPI assigned

Oct 16, 2006

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 1

Medicare fee-for-service enrollment

Enrolled in CA, UT2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Derm Haven Inc

  • Dermatology Physician
  • St George, UT
  • NPI 1164164141
  Medicare reassignment Authorized official
• Ravi Patel M.D. Inc

  • Specialist
  • Bakersfield, CA
  • NPI 1912978834
  Medicare reassignment
• Kenny R. Malott M.D. Inc.

  • Dermatology Physician
  • Kihei, HI
  • NPI 1265902670
  NPD (past)

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652918400000",
    "number": "1245310044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6501 TRUXTUN AVE",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933090633",
            "telephone_number": "661-322-2206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6501 TRUXTUN AVE",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933090633",
            "telephone_number": "661-322-2206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUSSALLY",
        "first_name": "TINA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "MSPA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-16",
        "last_updated": "2022-05-19",
        "certification_date": "2022-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA17710",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PA17710",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexandria Moten
• Artisa Mae Moten
• Sumanth Vamshidhar Mothe, PA-C, M.M.S
• Amber Lynn Motter, RADT
• Alice Faye Moundafie
• Michael Lowell Moustakis II
• Move International
• Move International
• Movement Space Physical Therapy
• Thomas Wayne Moxley, M.D.

• Physician Assistant in Bakersfield, CA
• Providers in Bakersfield, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2022; 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.