Active NPI
Timothy Moody, M.D.
- Public Health & General Preventive Medicine Physician
- Pullman, WA
National Provider Identifier
1396773222
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Public Health & General Preventive Medicine Physician
- License
- MD00025084
- Practice address
- 825 SE Bishop Blvd Ste 200
Pullman, WA 99163-5537 - Phone
- (509) 332-2517
- Fax
- (509) 334-9247
- NPI assigned
- Jun 29, 2006
- Last updated
- Jul 9, 2007
- 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 |
|---|---|---|---|---|
| Public Health & General Preventive Medicine Physician | 2083P0901X | MD00025084 | WA | Primary |
Addresses
Primary practice location
825 SE Bishop Blvd Ste 200
Pullman, WA 99163-5537
Mailing address
825 SE Bishop Blvd Ste 200
Pullman, WA 99163-5537
Phone (509) 332-2517
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8131435 | 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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00025084 | WA | MD | Public Health & General Preventive Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peter J. Martin | Past | Accepting new patients | |
| Peter J Martin | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1396773222",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "825 SE BISHOP BLVD STE 200",
"city": "PULLMAN",
"state": "WA",
"postal_code": "991635537",
"telephone_number": "509-332-2517",
"fax_number": "509-334-9247"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "825 SE BISHOP BLVD STE 200",
"city": "PULLMAN",
"state": "WA",
"postal_code": "991635537",
"telephone_number": "509-332-2517",
"fax_number": "509-334-9247"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOODY",
"first_name": "TIMOTHY",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-29",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "2083P0901X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Public Health & General Preventive Medicine",
"state": "WA",
"license": "MD00025084",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8131435",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pullman, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.