Johnathan M Moore, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

55 Green Hollow Rd
Danielson, CT 06239-3533

Phone

(860) 779-1865

NPI assigned

Dec 21, 2021

Last updated

Aug 23, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

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

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Day Kimball Medical Group IncGroup PAC ID 1557514411, 91 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Day Kimball Hospital Hospital, Putnam, CT, CCN 070003

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: johnathan.moore.1@1694.direct.athenahealth.com

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.

• Day Kimball Medical Group Inc

  • Family Medicine Physician
  • Putnam, CT
  • NPI 1376813972
  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Day Kimball Healthcare, Inc.

  • General Acute Care Hospital
  • Putnam, CT
  • NPI 1205056371
  Care Compare affiliation
• Day Kimball Healthcare, Inc.

  • General Acute Care Hospital
  • Putnam, CT
  • NPI 1649243478
  Care Compare affiliation

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

{
    "created_epoch": "1640044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661212800000",
    "number": "1467112250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 N JAMES ST APT 2",
            "city": "PEEKSKILL",
            "state": "NY",
            "postal_code": "105662486",
            "telephone_number": "401-300-7652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 GREEN HOLLOW RD",
            "city": "DANIELSON",
            "state": "CT",
            "postal_code": "062393533",
            "telephone_number": "860-779-1865"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 Washington Rd",
            "address_purpose": "LOCATION",
            "city": "West Point",
            "state": "NY",
            "postal_code": "109961109",
            "country_code": "US",
            "telephone_number": "845-938-0482",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "JOHNATHAN",
        "middle_name": "M",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-12-21",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Mazzola
• Charity McClure, APRN
• Sarah McCurdy, LCSW
• Kyle S McLaughlin, PHARMD
• Timothy Patrick Monahan, M.D.
• Lorna Kay Murdock, APRN
• Patrick F Muro
• Jocelyn R Nadeau, M.A.
• Sonia Nieminen, LPC
• Shonda M Northup

• Physician Assistant in Danielson, CT
• Providers in Danielson, CT by specialty
• Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.