Individual provider Active NPI

Jessica Nichole Moseley, MD

  • Diagnostic Radiology Physician
  • Los Angeles, CA
National Provider Identifier
1750724209
Registry record updated Nov 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
A136800 Issued in CA
Practice address
1500 San Pablo St
Los Angeles, CA 90033-5313
Phone
(323) 442-8541
Fax
(323) 442-8755
NPI assigned
Apr 15, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X ML60370491 WA
Student in an Organized Health Care Education/Training Program 390200000X
Diagnostic Radiology Physician 2085R0202X A136800 CA Primary

Addresses

Primary practice location

1500 San Pablo St
Los Angeles, CA 90033-5313

Mailing address

PO Box 31309
Los Angeles, CA 90031-0309
Phone (323) 442-8541

Other practice location 1

1505 N Edgemont St Bsmt
Kaiser Los Angeles Medical Center
Los Angeles, CA 90027-5209
Phone (323) 699-0596

Other identifiers 1

IdentifierTypeStateIssuer
ML60370491OtherWAMEDICAL LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170308001196 CA Practitioner - Diagnostic RadiologyPractitioner - Interventional Radiology 8820304157 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic RadiologyAlso: Interventional Radiology
Education
University of Washington School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern California Permanente Medical GroupGroup PAC ID 6002729175, shared by 4 NPIs, 11,250 clinicians

Practice addresses (Care Compare)

9333 Imperial Hwy
Downey, CA 90242-2812
Phone (800) 923-4040

9333 Rosecrans Ave
Bellflower, CA 90706-2141
Phone (562) 461-3000

9353 Imperial Hwy
Downey, CA 90242-2812
Phone (562) 657-9000

9449 Imperial Hwy
Downey, CA 90242-2814
Phone (562) 461-3000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A136800CAMDDiagnostic Radiology Physician
ML60370491WAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Usc Care Medical Group, Inc Diagnostic Radiology CurrentSince Jun 1, 2018 Accepting new patients
Usc Care Medical Group, Inc CurrentSince Jun 1, 2018 Accepting new patients
Southern California Permanente Medical Group CurrentSince Jan 29, 2017 Accepting new patients
Southern California Permanente Medical Group CurrentSince Jan 29, 2017 Accepting new patients
Southern California Permanente Medical Group CurrentSince Dec 10, 2019 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients

Locations

5475 E La Palma Ave
Anaheim, CA 92807
Phone (714) 279-6088

3733 San Dimas St
Ste 101
Bakersfield, CA 93301
Phone (800) 353-5400

9333 Rosecrans Ave
Bellflower, CA 90706
Phone (562) 461-3340

9333 Imperial Hwy
Downey, CA 90242
Phone (562) 657-8850

9961 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3910

25825 Vermont Ave
Harbor City, CA 90710
Phone (310) 325-5111

1520 San Pablo St
Los Angeles, CA 90033
Phone (323) 442-5849

1505 N Edgemont St
Bsmt
Los Angeles, CA 90027
Phone (323) 699-0488

6041 Cadillac Ave
Los Angeles, CA 90034
Phone (323) 857-2000

4733 W Sunset Blvd
Los Angeles, CA 90027
Phone (213) 667-4784

1500 San Pablo St
Los Angeles, CA 90033
Phone (323) 443-8500

13652 Cantara St
Panorama City, CA 91402
Phone (818) 375-2417

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

10800 Magnolia Ave
Riverside, CA 92505
Phone (951) 353-2000

4647 Zion Ave
San Diego, CA 92120
Phone (619) 528-3038

1255 W Arrow Hwy
San Dimas, CA 91773
Phone (909) 394-2526

888 S Hill Rd
Ventura, CA 93003
Phone (805) 477-6400

5601 De Soto Ave
Woodland Hls, CA 91367
Phone (818) 719-2000

Organizations & group practices 7

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.

Hospital & facility affiliations 1

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": "1365984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638144000000",
    "number": "1750724209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31309",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900310309",
            "telephone_number": "323-442-8541",
            "fax_number": "323-442-8755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 SAN PABLO ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900335313",
            "telephone_number": "323-442-8541",
            "fax_number": "323-442-8755"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1505 N Edgemont St Bsmt",
            "address_2": "Kaiser Los Angeles Medical Center",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900275209",
            "country_code": "US",
            "telephone_number": "323-699-0596",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOSELEY",
        "first_name": "JESSICA",
        "middle_name": "NICHOLE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-15",
        "last_updated": "2021-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WA",
            "license": "ML60370491",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A136800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "ML60370491",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "9333 Imperial Hwy",
            "city": "Downey",
            "state": "CA",
            "country_code": "US",
            "postal_code": "902422812",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.