NPIMap

Individual provider Active NPI

Jacqueline Faith Moore, PA-C

  • Physician Assistant
  • Albany, OR
National Provider Identifier
1679945000
Registry record updated Nov 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA175138 Issued in OR
Practice address
400 Hickory St NW Ste 303
Albany, OR 97321-1700
Phone
(541) 812-5275
NPI assigned
Oct 26, 2015
Last updated
Nov 20, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 20, 2023

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 PA175138 OR Primary

Addresses

Primary practice location

400 Hickory St NW Ste 303
Albany, OR 97321-1700

Mailing address

PO Box 1189
Corvallis, OR 97339-1189
Phone (541) 768-7999

Other practice location 1

5234 SW Philomath Blvd
Corvallis, OR 97333-1042
Phone (541) 768-4970

Other names 1

  • Jacqueline Fitch Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jmoore126059@samhealth.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20151207001133 OR Practitioner - Physician Assistant 9638479124 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Albany General HospitalGroup PAC ID 9931097987, 191 clinicians
Good Samaritan Hospital CorvallisGroup PAC ID 1557270725, 372 clinicians

Practice addresses (Care Compare)

1970 14TH Ave SE
Suite 130
Albany, OR 97322-8527
Phone (541) 812-5670

2555 NE Belvue St
Corvallis, OR 97330-4202
Phone (541) 768-2220

3600 NW Samaritan Dr
Corvallis, OR 97330-3737

705 Elm St SW
Suite 200
Albany, OR 97321-1957
Phone (541) 812-4850

990 NW Circle Blvd
Corvallis, OR 97330-1967

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.14 of 100Reported as group
Quality
85.78
Promoting interoperability
100
Improvement activities
40
Cost
78.31

Merit-based Incentive Payment System (MIPS)

Final score
94.37 of 100Reported as group
Quality
92.31
Promoting interoperability
100
Improvement activities
40
Cost
80.9

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA175138ORMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mid-Valley Healthcare, Inc. CurrentSince Nov 4, 2015 Accepting new patients
Good Samaritan Hospital Corvallis CurrentSince Feb 6, 2018 Accepting new patients
Good Samaritan Hospital Corvallis CurrentSince Feb 6, 2018 Accepting new patients
Mid-Valley Healthcare Inc CurrentSince Nov 4, 2015 Accepting new patients
Albany General Hospital CurrentSince Dec 5, 2017 Accepting new patients
Albany General Hospital CurrentSince Dec 5, 2017 Accepting new patients

Locations

705 Elm St SW
Ste 200
Albany, OR 97321
Phone (541) 812-4850

400 Hickory St NW
Ste 303
Albany, OR 97321
Phone (541) 812-5275

3600 NW Samaritan Dr
Ste 227
Corvallis, OR 97330
Phone (541) 768-1261

3600 NW Samaritan Dr
Corvallis, OR 97330
Phone (541) 768-4906

5234 SW Philomath Blvd
Corvallis, OR 97333
Phone (541) 768-4970

325 Park St
Lebanon, OR 97355
Phone (541) 451-7200

Interoperability endpoints

  • Direct secure messaging: jmoore126059@samhealth.direct-ci.com

Organizations & group practices 9

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.

Hospital & facility affiliations 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1445817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700438400000",
    "number": "1679945000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1189",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973391189",
            "telephone_number": "541-768-7999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 HICKORY ST NW STE 303",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973211700",
            "telephone_number": "541-812-5275"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5234 SW Philomath Blvd",
            "address_purpose": "LOCATION",
            "city": "Corvallis",
            "state": "OR",
            "postal_code": "973331042",
            "country_code": "US",
            "telephone_number": "541-768-4970",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "JACQUELINE",
        "middle_name": "FAITH",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-26",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA175138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmoore126059@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "5234 SW Philomath Blvd",
            "city": "Corvallis",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973331042",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "FITCH",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Albany, OR

Sources for this page

Verify at the official NPI Registry.