Individual provider Active NPI

Raymond Moreno Jr., PA-C

  • Surgical Physician Assistant
  • Federal Way, WA
National Provider Identifier
1407314735
Registry record updated Sep 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA60999802 Issued in WA
Practice address
34509 9TH Ave S Ste 204
Federal Way, WA 98003-8708
Phone
(253) 835-5510
Fax
(253) 835-5511
NPI assigned
Mar 5, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA60999802 WA Primary

Addresses

Primary practice location

34509 9TH Ave S Ste 204
Federal Way, WA 98003-8708

Mailing address

34509 9TH Ave S Ste 204
Federal Way, WA 98003-8708
Phone (253) 835-5510

Other identifiers 1

IdentifierTypeStateIssuer
2144135MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jmoreno687636@fhsce.catholichealth.net Direct Franciscan Medical Group

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
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA60999802WAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Proliance Surgeons Inc P S Surgical CurrentSince Nov 25, 2019 Accepting new patients
Proliance Surgeons Inc P S Surgical CurrentSince Nov 25, 2019 Accepting new patients

Locations

34509 9th Ave S
Ste 204
Federal Way, WA 98003
Phone (253) 835-5510

12911 120th Ave NE
Ste G10
Kirkland, WA 98034
Phone (425) 481-6301

12911 120th Ave NE
Ste H120
Kirkland, WA 98034
Phone (425) 823-4226

12911 120th Ave NE
Ste H210
Kirkland, WA 98034
Phone (425) 823-4000

14841 179th Ave SE
Ste 330
Monroe, WA 98272
Phone (360) 794-3300

805 Madison St
Ste 901
Seattle, WA 98104
Phone (206) 264-8100

Interoperability endpoints

  • Direct secure messaging: jmoreno687636@fhsce.catholichealth.net

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1551744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631491200000",
    "number": "1407314735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34509 9TH AVE S STE 204",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980038708",
            "telephone_number": "253-835-5510",
            "fax_number": "253-835-5511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34509 9TH AVE S STE 204",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980038708",
            "telephone_number": "253-835-5510",
            "fax_number": "253-835-5511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORENO",
        "first_name": "RAYMOND",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-05",
        "last_updated": "2021-09-13",
        "certification_date": "2021-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA60999802",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2144135",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmoreno687636@fhsce.catholichealth.net",
            "affiliation": "Y",
            "affiliationName": "Franciscan Medical Group",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "34509 9th Ave S Ste 204",
            "city": "Federal Way",
            "state": "WA",
            "country_code": "US",
            "postal_code": "980038708",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Federal Way, WA

Sources for this page

Verify at the official NPI Registry.