Active NPI
Cathy Shabaz Moore, PA-C
- Physician Assistant
- Bloomington, MN
National Provider Identifier
1477641017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 9909
- Practice address
- 9220 James Ave S Ste 1
Bloomington, MN 55431-4504 - Phone
- (952) 234-5898
- NPI assigned
- Oct 10, 2006
- Last updated
- Sep 2, 2022
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 9909 | MN | Primary |
Addresses
Primary practice location
9220 James Ave S Ste 1
Bloomington, MN 55431-4504
Mailing address
7993 172ND St W
Lakeville, MN 55044-9132
Phone (763) 301-2032
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9909 | MN | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medaisle Express, LLC | Past | Accepting new patients | |
| Renown Urgent Care LLC | Physician Assistant | Past | Accepting new patients |
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.
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Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1662076800000",
"number": "1477641017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7993 172ND ST W",
"city": "LAKEVILLE",
"state": "MN",
"postal_code": "550449132",
"telephone_number": "763-301-2032"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9220 JAMES AVE S STE 1",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554314504",
"telephone_number": "952-234-5898"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "CATHY",
"middle_name": "SHABAZ",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-10",
"last_updated": "2022-09-02",
"certification_date": "2022-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MN",
"license": "9909",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.