Individual provider Active NPI

Raakiyah Moore, PA-C

  • Physician Assistant
  • Edinburg, TX
National Provider Identifier
1699407650
Registry record updated May 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA16681 Issued in TX
Practice address
1201 W University Dr
Edinburg, TX 78539-2909
Phone
(956) 665-7049
NPI assigned
Jun 28, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X PA16681 TX Primary

Addresses

Primary practice location

1201 W University Dr
Edinburg, TX 78539-2909

Mailing address

11511 Shadow Creek Pkwy
Pearland, TX 77584-7298
Phone (713) 442-0000

Other practice location 1

106 Vision Park Blvd
Shenandoah, TX 77384-3000
Phone (713) 442-1800

Other practice location 2

15655 Cypress Wood Medical Dr Ste 100
Houston, TX 77014-1487
Phone (713) 442-1700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20230519002240 TX Practitioner - Physician Assistant 8729444575 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kelsey-Seybold Medical Group, PLLCGroup PAC ID 9739093527, 941 clinicians

Practice addresses (Care Compare)

22407 Holzwarth Rd
Spring, TX 77389-1933
Phone (346) 674-4000

2727 W Holcombe Blvd
Houston, TX 77025-1669
Phone (713) 442-0000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA16681TXMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: rmoore59083@direct.kelsey-seybold.com

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1656374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683676800000",
    "number": "1699407650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11511 SHADOW CREEK PKWY",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775847298",
            "telephone_number": "713-442-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 W UNIVERSITY DR",
            "city": "EDINBURG",
            "state": "TX",
            "postal_code": "785392909",
            "telephone_number": "956-665-7049"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "106 Vision Park Blvd",
            "address_purpose": "LOCATION",
            "city": "Shenandoah",
            "state": "TX",
            "postal_code": "773843000",
            "country_code": "US",
            "telephone_number": "713-442-1800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15655 Cypress Wood Medical Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770141487",
            "country_code": "US",
            "telephone_number": "713-442-1700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "RAAKIYAH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-28",
        "last_updated": "2023-05-10",
        "certification_date": "2023-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA16681",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edinburg, TX

Sources for this page

Verify at the official NPI Registry.