Shane Mozingo

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

10646550-3102 Issued in UT

Practice address

2841 N 920 E
North Logan, UT 84341-5806

Phone

(435) 512-1066

NPI assigned

Aug 19, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AK

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 1

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Atlas Medical Alaska LLCGroup PAC ID 0345630463, 6 clinicians

Atlas Medical Aco LLCGroup PAC ID 1456885227, 50 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mat-Su Regional Medical Center Hospital, Palmer, AK, CCN 020006
• Maple Springs of Palmer Nursing home, Palmer, AK, CCN 025039

Medicare enrollment (NPD)

Enrolled

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.

• Atlas Medical Aco LLC

  • Clinic/Center
  • Wasilla, AK
  • NPI 1629807086
  Medicare reassignment Care Compare group NPD
• Atlas Medical Alaska LLC

  • Internal Medicine Physician
  • Wasilla, AK
  • NPI 1376213207
  Medicare reassignment Care Compare group NPD
• Atlas Medical Aco LLC

  • Clinic/Center
  • Mesa, AZ
  • NPI 1396573705
  NPD
• South Sound Inpatient Physicians PLLC

  • Internal Medicine Physician
  • Hillsboro, OR
  • NPI 1508023789
  NPD

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

• Maple Springs of Palmer SNF Holdings, LLC

  • Skilled Nursing Facility
  • Palmer, AK
  • NPI 1548814718

  Nursing home

  Care Compare affiliation
• Mat-Su Valley Medical Center LLC

  • General Acute Care Hospital
  • Palmer, AK
  • NPI 1417975061
  Care Compare affiliation

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

{
    "created_epoch": "1597795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607904000000",
    "number": "1295347474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2841 N 920 E",
            "city": "NORTH LOGAN",
            "state": "UT",
            "postal_code": "843415806",
            "telephone_number": "435-512-1066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2841 N 920 E",
            "city": "NORTH LOGAN",
            "state": "UT",
            "postal_code": "843415806",
            "telephone_number": "435-512-1066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOZINGO",
        "first_name": "SHANE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-08-19",
        "last_updated": "2020-12-14",
        "certification_date": "2020-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "10646550-3102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacie Weeks Mecham, P.N.P.
• Brent Warburton Miller, MD
• Christopher James Morgan, DNP, FNP-C
• Mountain Division - CVH, LLC
• Mountain Division - CVH, LLC
• Michael Craig Mumford, DPT
• Josh Robert Novak, LMFT
• Erin Bagley Oberg, PA-C
• Heather Elizabeth Olsen, LCSW
• Ray Brock Olson, PA

• Family Nurse Practitioner in North Logan, UT
• Providers in North Logan, UT by specialty
• Family Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2020; 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.