Rebecca Ivry Moore, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PAD A 830 Issued in AK

Practice address

201 3Rd Ave
Suite 201
Seward, AK 99664

Phone

(907) 224-4916

Fax

(907) 224-5870

NPI assigned

Sep 7, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Mrs. Rebecca Ivry Moore Pazdernik Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1189123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1231804800000",
    "number": "1720273295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3262",
            "city": "SEWARD",
            "state": "AK",
            "postal_code": "996643262",
            "telephone_number": "907-224-4916",
            "fax_number": "907-224-5870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 3RD AVE",
            "address_2": "SUITE 201",
            "city": "SEWARD",
            "state": "AK",
            "postal_code": "99664",
            "telephone_number": "907-224-4916",
            "fax_number": "907-224-5870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "REBECCA",
        "middle_name": "IVRY",
        "name_prefix": "Mrs.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-07",
        "last_updated": "2009-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "19315",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AK",
            "license": "PAD A 830",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PA19315",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "REBECCA",
            "last_name": "MOORE PAZDERNIK",
            "middle_name": "IVRY",
            "prefix": "MRS.",
            "credential": "PAC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Michael J. Craytor, LPC
• Dakota Miles, LPC
• Brenda K Miller
• Kevin Nathaniel Miller, LPN
• Laura Moore
• Marcilena Gabrielle Moreno
• Michael P Moriarty, DDS
• Liria Guadalupe Morrell, PHARM.D.
• Carly Ness
• Matthew Phillip Nielsen, PHARMD.

• Physician Assistant in Seward, AK
• Providers in Seward, AK by specialty
• Physician Assistant in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.