NPIMap

Individual provider Active NPI

Kenneth P. Moses, MD

  • Emergency Medicine Physician
  • Oakland, CA
National Provider Identifier
1275543845
Registry record updated Mar 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
A70905 Issued in CA
Practice address
2107 Livingston St
Suite a
Oakland, CA 94606-5218
Phone
(510) 436-9000
Fax
(510) 436-9013
NPI assigned
Aug 8, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 5, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X A70905 CA Primary

Addresses

Primary practice location

2107 Livingston St
Suite a
Oakland, CA 94606-5218

Mailing address

2107 Livingston St
Suite a
Oakland, CA 94606-5218
Phone (510) 436-9000

Other identifiers 1

IdentifierTypeStateIssuer
00A709050MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20071102000651 CA Practitioner - Emergency Medicine 9032206347 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

173 E Webster St
Colusa, CA 95932-2949
Phone (209) 287-6308

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
26.89 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
89.62

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A70905CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Chase Dennis Emergency Medical Group Inc Emergency Medicine CurrentSince Dec 22, 2008 Accepting new patients
Eastern Plumas Health Care Home Health CurrentSince Jul 1, 2012 Accepting new patients
Glenn Medical Center, LLC Current Accepting new patients
Doctors Managed Emergency Medical Group Inc. Emergency Medicine CurrentSince Jul 19, 2024 Accepting new patients
American Specialty Physicians Group Inc Emergency Medicine CurrentSince Jun 23, 2018 Accepting new patients
Glenn Medical Center, LLC CurrentSince Apr 16, 2014 Accepting new patients
Glenn Medical Center, LLC CurrentSince Apr 16, 2014 Accepting new patients
Eastern Plumas Health Care District CurrentSince Jul 1, 2012 Accepting new patients
Glenn Medical Center, LLC Past Accepting new patients
Fairchild Medical Group Past Accepting new patients

Locations

1191 Phelps Ave
Coalinga, CA 93210
Phone (559) 897-5841

151 E Webster St
Ste B
Colusa, CA 95932
Phone (209) 287-6308

4081 E Olympic Blvd
Los Angeles, CA 90023
Phone (323) 267-0477

700 17th St
Ste 205
Modesto, CA 95354
Phone (209) 248-7851

500 1st Ave
Portola, CA 96122
Phone (530) 832-4277

480 1st Ave
Portola, CA 96122
Phone (530) 832-6600

1065 Bucks Lake Rd
Quincy, CA 95971
Phone (530) 283-2121

1133 W Sycamore St
Willows, CA 95988
Phone (530) 934-1800

435 Del Norte Ave
Yuba City, CA 95991
Phone (530) 751-7201

Organizations & group practices 10

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 4

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": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204675200000",
    "number": "1275543845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2107 LIVINGSTON ST",
            "address_2": "SUITE A",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946065218",
            "telephone_number": "510-436-9000",
            "fax_number": "510-436-9013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2107 LIVINGSTON ST",
            "address_2": "SUITE A",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946065218",
            "telephone_number": "510-436-9000",
            "fax_number": "510-436-9013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSES",
        "first_name": "KENNETH",
        "middle_name": "P.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2008-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A70905",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A709050",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, CA

Sources for this page

Verify at the official NPI Registry.