Individual provider Active NPI

Sydney Erin Moosekian, PA-C

  • Physician Assistant
  • East Lansing, MI
National Provider Identifier
1619605656
Registry record updated Jun 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601011192 Issued in MI
Practice address
4660 S Hagadorn Rd Ste 420
East Lansing, MI 48823-5353
Phone
(517) 884-6100
Fax
(517) 884-6233
NPI assigned
Aug 9, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 27, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 5601011192 MI
Surgical Physician Assistant 363AS0400X 5601011192 MI
Physician Assistant 363A00000X 5601011192 MI Primary

Addresses

Primary practice location

4660 S Hagadorn Rd Ste 420
East Lansing, MI 48823-5353

Mailing address

804 Service Rd Ste A109B
East Lansing, MI 48824-7015
Phone (517) 884-6100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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

Enrollment IDStateProvider typePAC IDDetails
I20220923000500 MI Practitioner - Physician Assistant 5395120505 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Pennsylvania State University College of Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Msu Health Care Inc.Group PAC ID 8628404936, 201 clinicians

Practice addresses (Care Compare)

4660 S Hagadorn Rd
East Lansing, MI 48823-5353

4660 S Hagadorn Rd
Suite 500
East Lansing, MI 48823-6804
Phone (517) 884-4554

Hospital & facility affiliations

  • McLaren Greater Lansing Hospital, Lansing, MI, CCN 230167

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5601011192MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Msu Health Care Inc. CurrentSince Oct 10, 2022 Accepting new patients
Msu Health Care Inc. CurrentSince Oct 10, 2022 Accepting new patients

Locations

804 Service Rd
Ste A109B
East Lansing, MI 48824
Phone (517) 884-2976

4660 S Hagadorn Rd
Ste 500
East Lansing, MI 48823
Phone (517) 432-6144

4660 S Hagadorn Rd
Ste 420
East Lansing, MI 48823
Phone (517) 884-6100

Interoperability endpoints

  • Direct secure messaging: sydney.moosekian.1@25394.direct.athenahealth.com

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1660003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687824000000",
    "number": "1619605656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 SERVICE RD STE A109B",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488247015",
            "telephone_number": "517-884-6100",
            "fax_number": "517-884-6233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4660 S HAGADORN RD STE 420",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488235353",
            "telephone_number": "517-884-6100",
            "fax_number": "517-884-6233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOOSEKIAN",
        "first_name": "SYDNEY",
        "middle_name": "ERIN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-08-09",
        "last_updated": "2023-06-27",
        "certification_date": "2023-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601011192",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MI",
            "license": "5601011192",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601011192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Lansing, MI

Sources for this page

Verify at the official NPI Registry.