Adam Derek-Alan Moffatt, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601011331TMP22 Issued in MI

Practice address

1951 S Otsego Ave
Gaylord, MI 49735-8489

Phone

(989) 732-3284

Fax

(989) 732-6395

NPI assigned

Aug 29, 2022

Sex

Male

Sole proprietor

No

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 MI

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

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Alcona Citizens for Health IncGroup PAC ID 5991691958, 65 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tawas St Joseph Hospital Hospital, Tawas City, MI, CCN 230100
• Mymichigan Medical Center Alpena Hospital, Alpena, MI, CCN 230036

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: adam.moffatt.p1@direct.alcona.nextgenshare.com

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.

• Alcona Citizens for Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Harrisville, MI
  • NPI 1326055450

  Physician Assistant

  Medicare reassignment Care Compare group NPD
• Boyne Country Urgent Care P.C.

  • Dermatopathology Physician
  • Gaylord, MI
  • NPI 1972556702
  Medicare reassignment
• Alcona Citizens for Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Alpena, MI
  • NPI 1750159158
  NPD
• Alcona Citizens for Health Inc

  • Community/Retail Pharmacy
  • Alpena, MI
  • NPI 1407949845
  NPD (past)

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

• Mymichigan Medical Center Alpena

  • Rural Acute Care Hospital
  • Sault Sainte Marie, MI
  • NPI 1619791431
  Care Compare affiliation
• Mymichigan Medical Center Alpena

  • Rural Acute Care Hospital
  • Alpena, MI
  • NPI 1619914652
  Care Compare affiliation
• Mymichigan Medical Center Alpena

  • Internal Medicine Physician
  • Alpena, MI
  • NPI 1942302302

  Hospital

  Care Compare affiliation
• Mymichigan Medical Center Tawas

  • Internal Medicine Physician
  • Tawas City, MI
  • NPI 1003996679

  Hospital

  Care Compare affiliation
• Mymichigan Medical Center Tawas

  • Rural Health Clinic/Center
  • Tawas City, MI
  • NPI 1164410841

  Hospital

  Care Compare affiliation
• Mymichigan Medical Center Tawas

  • General Acute Care Hospital
  • Tawas City, MI
  • NPI 1194713461
  Care Compare affiliation
• Mymichigan Medical Center Tawas

  • Rural Health Clinic/Center
  • Au Gres, MI
  • NPI 1326036153

  Hospital

  Care Compare affiliation
• Mymichigan Medical Center Tawas

  • Rural Health Clinic/Center
  • Tawas City, MI
  • NPI 1679561468

  Hospital

  Care Compare affiliation
• Mymichigan Medical Center Tawas

  • Rural Health Clinic/Center
  • Tawas City, MI
  • NPI 1952399743

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1661731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661731200000",
    "number": "1386364784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1951 S OTSEGO AVE",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497358489",
            "telephone_number": "989-732-3284",
            "fax_number": "989-732-6395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1951 S OTSEGO AVE",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497358489",
            "telephone_number": "989-732-3284",
            "fax_number": "989-732-6395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOFFATT",
        "first_name": "ADAM",
        "middle_name": "DEREK-ALAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-29",
        "last_updated": "2022-08-29",
        "certification_date": "2022-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601011331TMP22",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emma Mitchell
• Keith Y Miyamoto, M.D.
• MLD Supervision & Therapy, LLC
• Taylor Moeggenerg
• John David Moffat, M.D.
• Megan Louise Montgomery, LMT
• Nicole Montgomery, LMSW
• Sandra K Montgomery
• Jill Moore, RN, CDE
• Joseph Harold Moore, LPC

• Physician Assistant in Gaylord, MI
• Providers in Gaylord, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2022; 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.