Active NPI
Raymond Moreno Jr., PA-C
- Surgical Physician Assistant
- Federal Way, WA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- PA60999802
- 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
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 |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2144135 | Medicaid | WA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| 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
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA60999802 | WA | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Proliance Surgeons Inc P S | Surgical | Current | Accepting new patients |
| Proliance Surgeons Inc P S | Surgical | Current | 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
- 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.