Individual provider Active NPI

Moira Kehoe, NP

  • Women's Health Nurse Practitioner
  • Paradise, CA
National Provider Identifier
1366658445
Registry record updated Apr 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
15686 Issued in CA
Practice address
5125 Skyway
Paradise, CA 95969-5624
Phone
(530) 872-2000
NPI assigned
May 15, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2024

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 15686 CA Primary

Addresses

Primary practice location

5125 Skyway
Paradise, CA 95969-5624

Mailing address

5125 Skyway
Paradise, CA 95969-5624

Other identifiers 4

IdentifierTypeStateIssuer
ZZR11629FMedicaidCA
CMM70116GMedicaidCA
CMM70268FMedicaidCA
CMM70370FMedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20111026000100 CA Practitioner - Nurse Practitioner 4688847346 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
95.77 of 100Reported as apm
Quality
81.54
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
15686CAMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health Clearlake Hospital Inc. CurrentSince Mar 1, 2024 Accepting new patients
Adventist Health Clearlake Hospital, Inc Past Accepting new patients
Rideout Memorial Hospital Past Accepting new patients
Michael R. Cosenza, DPM, Inc. PastSince Feb 28, 2018 Accepting new patients

Locations

15630 18th Ave
Clearlake, CA 95422
Phone (707) 995-5820

5125 Skyway
Paradise, CA 95969
Phone (530) 872-2000

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712016000000",
    "number": "1366658445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5125 SKYWAY",
            "city": "PARADISE",
            "state": "CA",
            "postal_code": "959695624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5125 SKYWAY",
            "city": "PARADISE",
            "state": "CA",
            "postal_code": "959695624",
            "telephone_number": "530-872-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEHOE",
        "first_name": "MOIRA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-15",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "CA",
            "license": "15686",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZR11629F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM70116G",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM70268F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM70370F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Paradise, CA

Sources for this page

Verify at the official NPI Registry.