Active NPI
Dennis Miles Moberg, CRNA
- Certified Registered Nurse Anesthetist
- Augusta, GA
National Provider Identifier
1700844073
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- RN077262
- Practice address
- 3651 Wheeler Rd
Augusta, GA 30909-6521 - Phone
- (706) 855-9860
- Fax
- (706) 860-7124
- NPI assigned
- May 3, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | RN077262 | GA | Primary |
Addresses
Primary practice location
3651 Wheeler Rd
Augusta, GA 30909-6521
Mailing address
3756 Roscommon S
Augusta, GA 30907-4742
Phone (706) 284-5670
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 430077077 | Other | GA | RAILROAD MEDICARE |
| AN0562 | Medicaid | SC | |
| 000616228B | Medicaid | GA | |
| 10065595 | Other | GA | AMERIGROUP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1529 | SC | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Anesthesia Consultants of Augusta, LLC | Past | Accepting new patients |
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.
-
- Anesthesiology Physician
- Augusta, GA
- NPI 1881877793
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1485216000000",
"number": "1700844073",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3756 ROSCOMMON S",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309074742",
"telephone_number": "706-284-5670"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3651 WHEELER RD",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309096521",
"telephone_number": "706-855-9860",
"fax_number": "706-860-7124"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOBERG",
"first_name": "DENNIS",
"middle_name": "MILES",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-03",
"last_updated": "2017-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "GA",
"license": "RN077262",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "430077077",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "AN0562",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000616228B",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIGROUP",
"identifier": "10065595",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Augusta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.