NPIMap

Individual provider Active NPI

William Ryan Moultray, DO

  • Family Medicine Physician
  • Naches, WA
National Provider Identifier
1528089695
Registry record updated Mar 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OP00001888 Issued in WA
Practice address
102 E 2ND St
Naches, WA 98937
Phone
(509) 653-2235
Fax
(509) 653-2236
NPI assigned
Jul 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2020

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 OP00001888 WA Primary

Addresses

Primary practice location

102 E 2ND St
Naches, WA 98937

Mailing address

501 S 5TH Ave
Yakima, WA 98902-3550
Phone (509) 494-6700

Other practice location 1

620 N. Park Drive
Selah, WA 98942-1326
Phone (509) 697-5511

Other practice location 2

1806 W Lincoln Ave
Yakima, WA 98902-2473
Phone (509) 452-4520

Other identifiers 2

IdentifierTypeStateIssuer
1012539MedicaidWA
0411500OtherWALABOR AND INDUSTRIES

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20050601000229 WA Practitioner - Family Practice 3870535776 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Health of Central Washington 77 clinicians

Practice addresses (Care Compare)

102 E 2ND St
Naches, WA 98937-9743
Phone (509) 653-2235

Hospital & facility affiliations

  • Mountainview Home Health Home health agency, Yakima, WA, CCN 507115
  • Memorial Home Care Services Home health agency, Yakima, WA, CCN 507028
  • Yakima Valley Memorial Hospital, Yakima, WA, CCN 500036
  • Prosser Memorial Hospital Hospital, Prosser, WA, CCN 501312

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OP00001888WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health of Central Washington CurrentSince Sep 16, 2019 Accepting new patients
Community Health of Central Washington Family Medicine CurrentSince Sep 16, 2019 Accepting new patients
Community Health of Central Washington Past Accepting new patients
Yakima Valley Memorial Hospital Association Past Accepting new patients
Community Health of Central Washington Family Medicine Past Accepting new patients

Locations

521 E Mountain View Ave
Ellensburg, WA 98926
Phone (509) 962-1414

1806 W Lincoln Ave
Yakima, WA 98902
Phone (509) 452-4520

501 S 5th Ave
Yakima, WA 98902
Phone (509) 494-6700

402 S 12th Ave
Bsmt
Yakima, WA 98902

402 S 12th Ave
Yakima, WA 98902
Phone (509) 248-3263

2811 Tieton Dr
Yakima, WA 98902
Phone (509) 249-5210

Interoperability endpoints

  • Direct secure messaging: wmoultray606157@direct.ochin.org
  • FHIR API: https://fhir-myrecord.cerner.com/r4/ef853cc1-94e4-4ed7-883a-9be7485e458e/
  • Direct secure messaging: wmoultray772941@direct.multicare.org

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584921600000",
    "number": "1528089695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S 5TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989023550",
            "telephone_number": "509-494-6700",
            "fax_number": "509-573-6275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 E 2ND ST",
            "city": "NACHES",
            "state": "WA",
            "postal_code": "98937",
            "telephone_number": "509-653-2235",
            "fax_number": "509-653-2236"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "620 N. Park Drive",
            "address_purpose": "LOCATION",
            "city": "Selah",
            "state": "WA",
            "postal_code": "989421326",
            "country_code": "US",
            "telephone_number": "509-697-5511",
            "fax_number": "509-697-9313",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1806 W Lincoln Ave",
            "address_purpose": "LOCATION",
            "city": "Yakima",
            "state": "WA",
            "postal_code": "989022473",
            "country_code": "US",
            "telephone_number": "509-452-4520",
            "fax_number": "509-452-5224",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOULTRAY",
        "first_name": "WILLIAM",
        "middle_name": "RYAN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-22",
        "last_updated": "2020-03-23",
        "certification_date": "2020-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "OP00001888",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1012539",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES",
            "identifier": "0411500",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Naches, WA

Sources for this page

Verify at the official NPI Registry.