Individual provider Active NPI

Kimberly Ann Moseley, MD

  • Surgery Physician
  • Santa Fe, NM
National Provider Identifier
1396832416
Registry record updated Feb 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
MD2011-0065 Issued in NM
Practice address
455 Saint Michaels Dr
Santa Fe, NM 87505-7601
Phone
(505) 913-3975
NPI assigned
Oct 9, 2006
Last updated
Feb 17, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2012

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X MD38996 TN
Surgery Physician 208600000X E-5272 AR
Surgery Physician 208600000X MD2011-0065 NM Primary

Addresses

Primary practice location

455 Saint Michaels Dr
Santa Fe, NM 87505-7601

Mailing address

455 Saint Michaels Dr
Santa Fe, NM 87505-7601
Phone (505) 913-3975

Other identifiers 1

IdentifierTypeStateIssuer
165024001MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-5272ARMDSurgery Physician
MD2011-0065NMMDSurgery Physician
MD38996TNMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Commonwealth Healthcare Corporation CurrentSince Feb 18, 2019 Accepting new patients
Commonwealth Healthcare Corporation CurrentSince Feb 18, 2019 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": "1160352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329436800000",
    "number": "1396832416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 SAINT MICHAELS DR",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875057601",
            "telephone_number": "505-913-3975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 SAINT MICHAELS DR",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875057601",
            "telephone_number": "505-913-3975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSELEY",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-09",
        "last_updated": "2012-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TN",
            "license": "MD38996",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AR",
            "license": "E-5272",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NM",
            "license": "MD2011-0065",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "165024001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Fe, NM

Sources for this page

Verify at the official NPI Registry.