Individual provider Active NPI

Sammee Moschettieri

  • Nurse Practitioner
  • Athens, GA
National Provider Identifier
1447856513
Registry record updated Jun 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
250359 Issued in GA
Practice address
1230 Baxter St
Athens, GA 30606-3712
Phone
(404) 441-0877
NPI assigned
Dec 4, 2020
Last updated
Jun 27, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 250359 GA
Nurse Practitioner 363L00000X 250359 GA Primary

Addresses

Primary practice location

1230 Baxter St
Athens, GA 30606-3712

Mailing address

2817B Dixie Ave
Savannah, GA 31404-4109
Phone (404) 441-0877

Other practice location 1

2817B Dixie Ave
Savannah, GA 31404-4109
Phone (404) 441-0877

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230810000387 GA Practitioner - Nurse Practitioner 4284096157 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
250359GAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Athens Clarke Medical Enterprises LLC Current Accepting new patients
Athens Clarke Medical Enterprises LLC CurrentSince Jun 19, 2023 Accepting new patients

Locations

1230 Baxter St
Athens, GA 30606
Phone (706) 364-3100

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

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": "1607040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687824000000",
    "number": "1447856513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2817B DIXIE AVE",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314044109",
            "telephone_number": "404-441-0877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1230 BAXTER ST",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306063712",
            "telephone_number": "404-441-0877"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2817B Dixie Ave",
            "address_purpose": "LOCATION",
            "city": "Savannah",
            "state": "GA",
            "postal_code": "314044109",
            "country_code": "US",
            "telephone_number": "404-441-0877",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOSCHETTIERI",
        "first_name": "SAMMEE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-04",
        "last_updated": "2023-06-27",
        "certification_date": "2023-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "250359",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "250359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Athens, GA

Sources for this page

Verify at the official NPI Registry.