Carlos Julio Moreno

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

006320 Issued in GA

Practice address

690 Dallas Hwy
Suite 101
Villa Rica, GA 30180-1264

Phone

(770) 459-0620

Fax

(770) 456-7604

NPI assigned

Dec 14, 2006

Last updated

Dec 19, 2011By 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 2

Addresses

Other identifiers 4

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

Specialty

Physician Assistant

Education

Miami Medical College, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Center for Allergy and Asthma of Georgia PCGroup PAC ID 2062460785, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Center for Allergy & Asthma of Georgia PC

  • Allergy & Immunology Physician
  • Villa Rica, GA
  • NPI 1578504536
  Medicare reassignment Care Compare group
• Center for Allergy and Asthma Southern Crescent

  • Allergy & Immunology Physician
  • Peachtree City, GA
  • NPI 1750902185
  NPD (past)

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324252800000",
    "number": "1477615862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "690 DALLAS HWY",
            "address_2": "SUITE 101",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301801264",
            "telephone_number": "770-459-0620",
            "fax_number": "770-456-7604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 DALLAS HWY",
            "address_2": "SUITE 101",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301801264",
            "telephone_number": "770-459-0620",
            "fax_number": "770-456-7604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORENO",
        "first_name": "CARLOS",
        "middle_name": "JULIO",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-14",
        "last_updated": "2011-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9102549",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "006320",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE - PHYSICIAN ASSISTANT",
            "identifier": "006320",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA LICENSE",
            "identifier": "PA9102549",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "292140500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Allyson Moffatt, LPC
• Danielle Monroe
• Fredric A Moore, D.M.D.
• Eric L Morante, PT
• Arcelica Knittyada Moreland
• Alishia Morgan, LPN
• Tyler Morris, PTA
• Jessica Morton
• Ashley Moultrie
• Muhammad Hasan Chauhan, DMD, PC (Smile Center Villa Rica)

• Physician Assistant in Villa Rica, GA
• Providers in Villa Rica, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2011; 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.