Individual provider Active NPI

Michelle A Moynihan

  • Women's Health Nurse Practitioner
  • Dartmouth, MA
National Provider Identifier
1316928427
Registry record updated Dec 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
187390 Issued in MA
Practice address
285 Old Westport Rd
Dartmouth, MA 02747-2356
Phone
(508) 999-8982
NPI assigned
Nov 7, 2005
Last updated
Dec 21, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X 187390 MA Primary

Addresses

Primary practice location

285 Old Westport Rd
Dartmouth, MA 02747-2356

Mailing address

77 Warren Street, 3Rd FL
Provider Enrollment Dept
Brighton, MA 02135
Phone (617) 562-5359

Other identifiers 1

IdentifierTypeStateIssuer
0321290MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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

Enrollment IDStateProvider typePAC IDDetails
I20051201000714 MA Practitioner - Nurse Practitioner 7517987845

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Citizens for Citizens, Inc. CurrentSince Sep 1, 2016 Accepting new patients
Citizens for Citizens, Inc. CurrentSince Sep 1, 2016 Accepting new patients
Good Samaritan Medical Practice Corp Past Accepting new patients
Steward Medical Group, Inc Past Accepting new patients
Steward Medical Group, Inc PastSince Feb 25, 2015 Accepting new patients

Locations

300 Hanover St
Ste 2E
Fall River, MA 02720
Phone (508) 673-2400

337 Hanover St
Fall River, MA 02720
Phone (508) 679-0198

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1356048000000",
    "number": "1316928427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 WARREN STREET, 3RD FL",
            "address_2": "PROVIDER ENROLLMENT DEPT",
            "city": "BRIGHTON",
            "state": "MA",
            "postal_code": "02135",
            "telephone_number": "617-562-5359",
            "fax_number": "617-562-5415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "285 OLD WESTPORT RD",
            "city": "DARTMOUTH",
            "state": "MA",
            "postal_code": "027472356",
            "telephone_number": "508-999-8982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOYNIHAN",
        "first_name": "MICHELLE",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-07",
        "last_updated": "2012-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "MA",
            "license": "187390",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0321290",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dartmouth, MA

Sources for this page

Verify at the official NPI Registry.