Moon V Tinajero-Simmaly, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA61511235 Issued in WA

Practice address

2101 NE 139TH St Ste 460
Vancouver, WA 98686-2325

Phone

(360) 487-2727

NPI assigned

Dec 2, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Katherine Tinajero Former name

Medicare fee-for-service enrollment

Enrolled in NV, WA2 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, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Legacy Salmon Creek HospitalGroup PAC ID 0446295711, 309 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Legacy Salmon Creek Medical Center Hospital, Vancouver, WA, CCN 500150

Merit-based Incentive Payment System (MIPS)

Final score

92.83 of 100Reported as group

Quality

96.26

Promoting interoperability

100

Improvement activities

40

Cost

79.84

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Legacy Salmon Creek Hospital

  • Clinic/Center
  • Vancouver, WA
  • NPI 1356357784
  Medicare reassignment Care Compare group NPD
• Intermountain Medical Holdings Nevada Inc

  • Internal Medicine Physician
  • Henderson, NV
  • NPI 1245997279
  Medicare reassignment
• Legacy Salmon Creek Hospital

  • General Acute Care Hospital
  • Vancouver, WA
  • NPI 1700809829
  NPD
• Intermountain Medical Holdings Nevada Inc

  • Home Health Agency
  • Las Vegas, NV
  • NPI 1689882557
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Legacy Salmon Creek Hospital

  • Clinic/Center
  • Vancouver, WA
  • NPI 1356357784

  Hospital

  Care Compare affiliation
• Legacy Salmon Creek Hospital

  • General Acute Care Hospital
  • Vancouver, WA
  • NPI 1700809829
  Care Compare affiliation

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

{
    "created_epoch": "1606867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714435200000",
    "number": "1295330694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2077",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972082077",
            "telephone_number": "503-413-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 NE 139TH ST STE 460",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986862325",
            "telephone_number": "360-487-2727"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6170 N Durango Dr Ste 130",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891493923",
            "country_code": "US",
            "telephone_number": "702-940-1550",
            "fax_number": "702-940-1551",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9280 W Sunset Rd Ste 426",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891484862",
            "country_code": "US",
            "telephone_number": "702-688-8110",
            "fax_number": "702-891-5080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TINAJERO-SIMMALY",
        "first_name": "MOON",
        "middle_name": "V",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-02",
        "last_updated": "2024-04-30",
        "certification_date": "2024-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA2358",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "58655",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA61511235",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PA2358",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295330694",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHERINE",
            "last_name": "TINAJERO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jacob Alexander Timmerman, MA
• Tracy Timmons, MD
• Timms Family Chiropractic, PLLC
• Brian R Timms, DC
• Timothy T Ross MD
• Michelle Tinajero
• Andrea Lynn Tindal
• Amanda M Tinkle, DMD
• Jennifer Tinsley, LCSW
• Holly N. Tipp, DPT

• Physician Assistant in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2024; 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.