NPIMap

Individual provider Active NPI

Ava R Moskin, MD

  • Family Medicine Physician
  • Portland, ME
National Provider Identifier
1457342735
Registry record updated Jul 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
015890 Issued in ME
Practice address
443 Congress St
2ND Floor
Portland, ME 04101-3531
Phone
(207) 797-8881
Fax
(207) 773-1697
NPI assigned
Nov 4, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 015890 ME Primary

Addresses

Primary practice location

443 Congress St
2ND Floor
Portland, ME 04101-3531

Mailing address

128 Lakeside Ave Ste 301
Burlington, VT 05401-5906
Phone (802) 448-9719

Other identifiers 2

IdentifierTypeStateIssuer
060449OtherMEBLUE CROSS BLUE SHIELD
290170099MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160727001154 CA Practitioner - Family Practice 3476553264 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
138399CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
University of California SFGH Medical Group CurrentSince Jun 11, 2016 Accepting new patients
University of California SFGH Medical Group Current Accepting new patients
University of California SFGH Medical Group Family Medicine CurrentSince Jun 11, 2016 Accepting new patients
UCSF Health Medical Foundation Past Accepting new patients
Children'S Hospital & Research Center at Oakland Past Accepting new patients
Mabel Wadsworth Women'S Health Center PastSince Jul 15, 2018 Accepting new patients
Planned Parenthood of Northern New England Past Accepting new patients
Planned Parenthood of Northern New England, Inc PastSince Jun 21, 2006 Accepting new patients

Locations

1001 Potrero Ave
Bldg 80
San Francisco, CA 94110
Phone (628) 206-8610

Organizations & group practices 8

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": "1131062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469059200000",
    "number": "1457342735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 LAKESIDE AVE STE 301",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054015906",
            "telephone_number": "802-448-9719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "443 CONGRESS ST",
            "address_2": "2ND FLOOR",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041013531",
            "telephone_number": "207-797-8881",
            "fax_number": "207-773-1697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSKIN",
        "first_name": "AVA",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-04",
        "last_updated": "2016-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ME",
            "license": "015890",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "060449",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "290170099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.