Active NPI
William A. Moss, PSY.D.
- Clinical Psychologist
- Rapid City, SD
National Provider Identifier
1629048483
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 416
- Practice address
- 3601 Canyon Lake Dr
Rapid City, SD 57702-3305 - Phone
- (605) 341-8647
- Fax
- (605) 341-0489
- NPI assigned
- Jan 25, 2006
- Last updated
- Oct 7, 2019
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 416 | SD | Primary |
Addresses
Primary practice location
3601 Canyon Lake Dr
Rapid City, SD 57702-3305
Mailing address
403 National St
Ste 1
Rapid City, SD 57702-5908
Phone (605) 341-8647
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6551862 | Medicaid | SD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 416 | SD | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State of South Dakota | Past | Accepting new patients | |
| State of South Dakota | Past | Accepting new patients |
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.
-
- Clinical Psychologist
- Rapid City, SD
- NPI 1033255146
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1570406400000",
"number": "1629048483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "403 NATIONAL ST",
"address_2": "STE 1",
"city": "RAPID CITY",
"state": "SD",
"postal_code": "577025908",
"telephone_number": "605-341-8647",
"fax_number": "605-341-0489"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3601 CANYON LAKE DR",
"city": "RAPID CITY",
"state": "SD",
"postal_code": "577023305",
"telephone_number": "605-341-8647",
"fax_number": "605-341-0489"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOSS",
"first_name": "WILLIAM",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-25",
"last_updated": "2019-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "SD",
"license": "416",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6551862",
"state": "SD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rapid City, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.