Individual provider Active NPI

Nancy Ann Moulton, PA

  • Physician Assistant
  • Knoxville, TN
National Provider Identifier
1720300767
Registry record updated Nov 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA1802 Issued in TN
Practice address
6703 Stone Mill Dr
Knoxville, TN 37919-7430
Phone
(865) 680-7387
NPI assigned
Feb 18, 2010
Last updated
Nov 4, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA1802 TN Primary
Surgical Physician Assistant 363AS0400X PA1802 TN

Addresses

Primary practice location

6703 Stone Mill Dr
Knoxville, TN 37919-7430

Mailing address

6703 Stone Mill Dr
Knoxville, TN 37919-7430
Phone (865) 680-7387

Other identifiers 1

IdentifierTypeStateIssuer
1524007MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20110725000795 TN Practitioner - Physician Assistant 8123296746 Reassigns benefits to 2 organizations
I20240702002663 IL Practitioner - Physician Assistant 8123296746 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rush University Medical GroupGroup PAC ID 5496658874, 1,521 clinicians

Practice addresses (Care Compare)

1700 W Van Buren St
Chicago, IL 60612-5500
Phone (312) 563-2875

516 S Loomis St
Chicago, IL 60607-2812
Phone (312) 942-5000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA1802TNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Rush University Medical Group CurrentSince Jun 30, 2024 Accepting new patients
Rush University Medical Center CurrentSince Jun 30, 2024 Accepting new patients
Blount Hospitalists PC Past Accepting new patients

Locations

1620 W Harrison St
Chicago, IL 60612
Phone (312) 942-4200

1700 W Van Buren St
#500
Chicago, IL 60612
Phone (312) 563-2875

75 Remittance Dr
Dept 1611
Chicago, IL 60675

Organizations & group practices 5

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 3

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": "1266451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604448000000",
    "number": "1720300767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6703 STONE MILL DR",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379197430",
            "telephone_number": "865-680-7387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6703 STONE MILL DR",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379197430",
            "telephone_number": "865-680-7387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOULTON",
        "first_name": "NANCY",
        "middle_name": "ANN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-18",
        "last_updated": "2020-11-04",
        "certification_date": "2020-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "PA1802",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TN",
            "license": "PA1802",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1524007",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

Verify at the official NPI Registry.