Active NPI
Pascual Sevilla-Moya, MD
- Family Medicine Physician
- Grant, MI
National Provider Identifier
1508801895
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 43010173174
- Practice address
- 11 N Maple St
Grant, MI 49327-7900 - Phone
- (231) 834-0444
- Fax
- (231) 834-0200
- NPI assigned
- Jun 19, 2006
- Reactivated
- Feb 28, 2008
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 43010173174 | MI | Primary |
Addresses
Primary practice location
11 N Maple St
Grant, MI 49327-7900
Mailing address
PO Box 7
Grant, MI 49327-0007
Phone (231) 834-0444
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8916 | Other | PR | MEDICAL LICENSE |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8916 | PR | MD | Clinical Psychologist |
| 43010173174 | MI | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150675200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455148800000",
"number": "1508801895",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7",
"city": "GRANT",
"state": "MI",
"postal_code": "493270007",
"telephone_number": "231-834-0444",
"fax_number": "231-834-0200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11 N MAPLE ST",
"city": "GRANT",
"state": "MI",
"postal_code": "493277900",
"telephone_number": "231-834-0444",
"fax_number": "231-834-0200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SEVILLA-MOYA",
"first_name": "PASCUAL",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-19",
"last_updated": "2016-02-11",
"deactivation_date": "2007-07-17",
"reactivation_date": "2008-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "43010173174",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL LICENSE",
"identifier": "8916",
"state": "PR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grant, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.