NPIMap

Individual provider Active NPI

Matthew Todd Moody, DO

  • Emergency Medicine Physician
  • Shelton, WA
National Provider Identifier
1386872869
Registry record updated Dec 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
OP60693700 Issued in WA
Practice address
901 Mountain View Dr
Shelton, WA 98584-4401
Phone
(360) 426-1611
NPI assigned
Jun 23, 2009
Last updated
Dec 12, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X OS015747 PA
Emergency Medicine Physician 207P00000X OP60693700 WA Primary

Addresses

Primary practice location

901 Mountain View Dr
Shelton, WA 98584-4401

Mailing address

PO Box 8500-8735
Philadelphia, PA 19178-0001
Phone (215) 456-7000

Other practice location 1

5501 Old York Rd
Philadelphia, PA 19141-3091
Phone (215) 456-6679

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, VA, WA3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20121023000010 TN Practitioner - Emergency Medicine 3870758139 Reassigns benefits to 3 organizations
I20130226000635 VA Practitioner - Emergency Medicine 3870758139 Reassigns benefits to 1 organization
I20170615000616 WA Practitioner - Emergency Medicine 3870758139 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tri-Cities Regional Emergency Physicians, PCGroup PAC ID 3678859477, 118 clinicians
Western Virginia Regional Emergency Physicians LLCGroup PAC ID 4183991227, 88 clinicians

Practice addresses (Care Compare)

400 N State of Franklin Rd
Johnson City, TN 37604-6035
Phone (423) 431-6111

58 Carrol St
Lebanon, VA 24266
Phone (276) 883-8000

700 Lilly Rd NE
Olympia, WA 98506-5115
Phone (360) 923-7000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Tri-Cities Regional Emergency Physicians, PC Emergency Medicine CurrentSince Mar 20, 2017 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Jan 1, 2022 Accepting new patients
Tri-Cities Observation Services, PC Emergency Medicine CurrentSince Dec 13, 2017 Accepting new patients
Lewis County Hospital District No. 1 Emergency Medicine CurrentSince Sep 23, 2021 Accepting new patients
Public Hospital District No 1 of Mason County Wa CurrentSince Jul 5, 2023 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Jan 1, 2022 Accepting new patients
Kaiser Foundation Health Plan of Washington Current Accepting new patients
Lewis County Hospital District No. 1 CurrentSince Sep 23, 2021 Accepting new patients
Steele Creek Physician Services PC CurrentSince Dec 10, 2025 Accepting new patients
Public Hospital District No 1 of Mason County CurrentSince Jul 5, 2023 Accepting new patients

Locations

1 Medical Park Blvd
Bristol, TN 37620
Phone (423) 390-0451

1501 W Elk Ave
Elizabethton, TN 37643
Phone (423) 542-1300

300 Med Tech Pkwy
Johnson City, TN 37604
Phone (423) 302-1000

400 N State of Franklin Rd
Johnson City, TN 37604
Phone (423) 431-1310

700 Lilly Rd NE
Olympia, WA 98506
Phone (360) 923-7000

19379 7th Ave NE
Poulsbo, WA 98370
Phone (360) 394-1000

200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530

901 Mountain View Dr
Shelton, WA 98584
Phone (360) 426-1611

9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800

Organizations & group practices 11

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1245715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765497600000",
    "number": "1386872869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8500-8735",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191780001",
            "telephone_number": "215-456-7000",
            "fax_number": "215-254-2599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 MOUNTAIN VIEW DR",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985844401",
            "telephone_number": "360-426-1611"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5501 Old York Rd",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191413091",
            "country_code": "US",
            "telephone_number": "215-456-6679",
            "fax_number": "215-456-8502",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOODY",
        "first_name": "MATTHEW",
        "middle_name": "TODD",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-23",
        "last_updated": "2025-12-12",
        "certification_date": "2025-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "OS015747",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WA",
            "license": "OP60693700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelton, WA

Sources for this page

Verify at the official NPI Registry.