Individual provider Active NPI

Daniel Moynihan, MD

  • Family Medicine Physician
  • Vancouver, WA
National Provider Identifier
1548280167
Registry record updated Nov 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD00030301 Issued in WA
Practice address
2525 NE 139TH St Ste 260
Vancouver, WA 98686-2719
Phone
(360) 735-8100
Fax
(360) 735-3400
NPI assigned
Jul 19, 2006
Last updated
Nov 5, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2007

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 MD00030301 WA Primary

Addresses

Primary practice location

2525 NE 139TH St Ste 260
Vancouver, WA 98686-2719

Mailing address

2525 NE 139TH St Ste 260
Vancouver, WA 98686-2719

Other identifiers 1

IdentifierTypeStateIssuer
8143174MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051025000730 WA Practitioner - Family Practice 2567489958 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD00030301WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Salmon Creek Hospital CurrentSince Oct 31, 2008 Accepting new patients
Legacy Salmon Creek Hospital CurrentSince Oct 31, 2008 Accepting new patients
Family Physicians Group PS Family Medicine Past Accepting new patients

Locations

2211 NE 139th St
Vancouver, WA 98686
Phone (360) 397-1985

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194220800000",
    "number": "1548280167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 NE 139TH ST STE 260",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986862719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 NE 139TH ST STE 260",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986862719",
            "telephone_number": "360-735-8100",
            "fax_number": "360-735-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOYNIHAN",
        "first_name": "DANIEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2007-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00030301",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8143174",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.