NPIMap

Individual provider Active NPI

Travis Reed Moulton, DO

  • Family Medicine Physician
  • Caldwell, ID
National Provider Identifier
1760744403
Registry record updated Jan 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
O-0765 Issued in ID
Practice address
1906 Fairview Ave
Ste 230
Caldwell, ID 83605-5407
Phone
(208) 459-4667
Fax
(208) 442-6520
NPI assigned
Jun 8, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X O-0765 ID Primary

Addresses

Primary practice location

1906 Fairview Ave
Ste 230
Caldwell, ID 83605-5407

Mailing address

PO Box 277976
Atlanta, GA 30384-7976

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address TRAVIS.MOULTON@hca3.eclinicaldirectplus.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140218001104 ID Practitioner - Family Practice 9638308091 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
West Valley Medical Group LLCGroup PAC ID 8729180310, 9 clinicians

Practice addresses (Care Compare)

1717 Arlington Ave
Caldwell, ID 83605-4802
Phone (208) 795-5072

1906 Fairview Ave
Caldwell, ID 83605-5432

745 S Progress Ave
Suite 120
Meridian, ID 83642-5607
Phone (208) 795-5073

Hospital & facility affiliations

  • Horizon Home Health West Home health agency, Caldwell, ID, CCN 137135
  • Auburn Crest Hospice Treasure Valley, LLC Hospice, Boise, ID, CCN 131570
  • West Valley Medical Center Hospital, Caldwell, ID, CCN 130014
  • St Luke'S Nampa Medical Center Hospital, Nampa, ID, CCN 130071
  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006
  • Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007
  • Saint Alphonsus Medical Center - Nampa Hospital, Nampa, ID, CCN 130013

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy13
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of skin lesions11
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
West Valley Medical Group LLC CurrentSince Jul 1, 2015 Accepting new patients
West Valley Medical Group Specialty Services LLC Past Accepting new patients
Caldwell Internal Medicine Professional Association Past Accepting new patients

Locations

1906 Fairview Ave
Ste 230
Caldwell, ID 83605
Phone (208) 795-5201

745 S Progress Ave
Ste 120
Meridian, ID 83642
Phone (208) 795-5073

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Auburn Crest Hospice Treasure Valley, LLCBoise, ID, CCN 131570 Hospice Corporate Director Oct 1, 2015

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1339113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643155200000",
    "number": "1760744403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 277976",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303847976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1906 FAIRVIEW AVE",
            "address_2": "STE 230",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836055407",
            "telephone_number": "208-459-4667",
            "fax_number": "208-442-6520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOULTON",
        "first_name": "TRAVIS",
        "middle_name": "REED",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-08",
        "last_updated": "2022-01-26",
        "certification_date": "2020-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "O-0765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "TRAVIS.MOULTON@hca3.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "1906 Fairview Ave",
            "address_2": "STE 230",
            "city": "Caldwell",
            "state": "ID",
            "country_code": "US",
            "postal_code": "836055407",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Caldwell, ID

Sources for this page

Verify at the official NPI Registry.