Individual provider Active NPI

Jonathan Moreno, PA

  • Physician Assistant
  • Forest, VA
National Provider Identifier
1679128490
Registry record updated Jun 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110006885 Issued in VA
Practice address
16890 Forest Rd
Forest, VA 24551-4059
Phone
(434) 200-7210
NPI assigned
Aug 8, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0110006885 VA Primary

Addresses

Primary practice location

16890 Forest Rd
Forest, VA 24551-4059

Mailing address

16890 Forest Rd
Forest, VA 24551-4059
Phone (434) 200-7210

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20191203002294 VA Practitioner - Physician Assistant 7113350299 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centra Medical Group LLCGroup PAC ID 4789606088, 709 clinicians

Practice addresses (Care Compare)

16890 Forest Rd
Forest, VA 24551-4059
Phone (434) 200-7210

1901 Tate Springs Rd
Lynchburg, VA 24501-1109
Phone (434) 947-3033

291 McBride LN
Gretna, VA 24557-2773
Phone (434) 656-1274

4830 Rucker Rd
Moneta, VA 24121-5281
Phone (540) 297-7181

Hospital & facility affiliations

  • Centra Health - Lynchburg Gen Hospital Hospital, Lynchburg, VA, CCN 490021

Merit-based Incentive Payment System (MIPS)

Final score
93.16 of 100Reported as apm
Quality
83.58
Promoting interoperability
94
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0110006885VAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Centra Medical Group, LLC CurrentSince Oct 14, 2019 Accepting new patients
Centra Medical Group, LLC CurrentSince Oct 14, 2019 Accepting new patients

Locations

1280A Main St
Altavista, VA 24517
Phone (434) 309-1165

115 Ambriar Plz
Amherst, VA 24521
Phone (434) 381-6090

1613 Oakwood St
Ste 201
Bedford, VA 24523
Phone (540) 586-4723

104 Carolina Ave
Brookneal, VA 24528
Phone (434) 376-2325

412 Namozine St
Burkeville, VA 23922
Phone (434) 767-4822

414 Park Ave
Danville, VA 24541
Phone (434) 791-4892

65 Brickyard Dr
Dillwyn, VA 23936
Phone (434) 414-1021

935 S Main St
Farmville, VA 23901
Phone (434) 315-5340

16890 Forest Rd
Forest, VA 24551
Phone (434) 200-7210

312 King St
Keysville, VA 23947
Phone (434) 315-2920

1937 Thomson Dr
Lynchburg, VA 24501
Phone (434) 200-6965

1901 Tate Springs Rd
Lynchburg, VA 24501
Phone (434) 200-3101

125 Nationwide Dr
Lynchburg, VA 24502
Phone (434) 200-3908

4830 Rucker Rd
Moneta, VA 24121
Phone (540) 297-7181

Organizations & group practices 2

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 7

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": "1565222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780617600000",
    "number": "1679128490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16890 FOREST RD",
            "city": "FOREST",
            "state": "VA",
            "postal_code": "245514059",
            "telephone_number": "434-200-7210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16890 FOREST RD",
            "city": "FOREST",
            "state": "VA",
            "postal_code": "245514059",
            "telephone_number": "434-200-7210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORENO",
        "first_name": "JONATHAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-08",
        "last_updated": "2026-06-05",
        "certification_date": "2026-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110006885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest, VA

Sources for this page

Verify at the official NPI Registry.