Active NPI
John Porter Moulton, M.D.
- Psychiatry Physician
- Spokane, WA
National Provider Identifier
1316987456
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MD00015837
- Practice address
- 105 W 8TH Ave
Ste 6055
Spokane, WA 99204-2302 - Phone
- (509) 455-9090
- Fax
- (509) 747-2118
- NPI assigned
- Jun 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | MD00015837 | WA | Primary |
Addresses
Primary practice location
105 W 8TH Ave
Ste 6055
Spokane, WA 99204-2302
Mailing address
105 W 8TH Ave
Ste 6055
Spokane, WA 99204-2302
Phone (509) 455-9090
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1048644 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00015837 | WA | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Health Association of Spokane | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Federally Qualified Health Center (FQHC)
- Spokane, WA
- NPI 1679363592
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185321600000",
"number": "1316987456",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 W 8TH AVE",
"address_2": "STE 6055",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992042302",
"telephone_number": "509-455-9090",
"fax_number": "509-747-2118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 W 8TH AVE",
"address_2": "STE 6055",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992042302",
"telephone_number": "509-455-9090",
"fax_number": "509-747-2118"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOULTON",
"first_name": "JOHN",
"middle_name": "PORTER",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-07",
"last_updated": "2007-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "WA",
"license": "MD00015837",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1048644",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Spokane, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.