Active NPI
Kirk Tracy Moss, M.D.
- Family Medicine Physician
- Columbus AFB, MS
National Provider Identifier
1396713194
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 2838
- Practice address
- 14TH MDG
201 Independence Dr
Columbus AFB, MS 39710 - Phone
- (662) 434-2273
- NPI assigned
- Mar 9, 2006
- Last updated
- Oct 21, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 31364 | AZ | |
| Family Medicine Physician | 207Q00000X | 2838 | AK | Primary |
Addresses
Primary practice location
14TH MDG
201 Independence Dr
Columbus AFB, MS 39710
Mailing address
14TH MDG, 201 Independence Drive, BLDG 1100
Columbus AFB, Ms 39710
Fpo, AA 93246
Phone 66243439710
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MD2838 | Medicaid | AK | |
| A0348 | Other | BLUE CROSS SUB |
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 |
|---|---|---|---|
| 2838 | AK | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Heart of Eagle River Medical Clinic | Family Medicine | Past | Accepting new patients |
| Jackson County Memorial Hospital Authority | Past | Accepting new patients | |
| River Cities Community Clinic Inc. | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Family Medicine Physician
- Eagle River, AK
- NPI 1033277041
-
- General Acute Care Hospital
- Altus, OK
- NPI 1093763781
-
- Primary Care Clinic/Center
- Bullhead City, AZ
- NPI 1144387713
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1477008000000",
"number": "1396713194",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "MIL",
"address_1": "14TH MDG, 201 INDEPENDENCE DRIVE, BLDG 1100",
"address_2": "COLUMBUS AFB, MS 39710",
"city": "FPO",
"state": "AA",
"postal_code": "93246",
"telephone_number": "66243439710"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14TH MDG",
"address_2": "201 INDEPENDENCE DR",
"city": "COLUMBUS AFB",
"state": "MS",
"postal_code": "39710",
"telephone_number": "662-434-2273"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOSS",
"first_name": "KIRK",
"middle_name": "TRACY",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-09",
"last_updated": "2016-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AZ",
"license": "31364",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AK",
"license": "2838",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "MD2838",
"state": "AK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS SUB",
"identifier": "A0348",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbus AFB, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.