Active NPI
Ericka Rose Moudry, P.A.
- Medical Physician Assistant
- Decorah, IA
National Provider Identifier
1770565186
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 001593
- Practice address
- 901 Montgomery St
Decorah, IA 52101-2325 - Phone
- (563) 382-2911
- Fax
- (563) 382-4143
- NPI assigned
- Nov 19, 2005
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 001593 | IA | Primary |
Addresses
Primary practice location
901 Montgomery St
Decorah, IA 52101-2325
Mailing address
901 Montgomery St
Decorah, IA 52101-2325
Phone (563) 382-2911
Other names 1
- Ericka Rose Mracek
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | emoudry595436@ehrdirect.mayoclinicmsg.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA, MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Winneshiek Medical Center
Practice addresses (Care Compare)
112 Jefferson St
West Union, IA 52175-1022
Phone (563) 422-3811
114 Main St S
Mabel, MN 55954-9754
Phone (507) 493-5115
901 Montgomery St
Decorah, IA 52101-2325
Phone (563) 382-2911
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001593 | IA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Winneshiek Medical Center | Current | Accepting new patients | |
| Winneshiek Medical Center | Current | Accepting new patients | |
| Iowa Heart Center PC | Past | Accepting new patients | |
| Plaza OB-GYN Associates | Past | Accepting new patients |
Locations
901 Montgomery St
Decorah, IA 52101
Phone (319) 382-2911
114 Main St S
Mabel, MN 55954
Phone (507) 493-5115
Interoperability endpoints
- emoudry157237@uihcdirect.org
- emoudry595436@ehrdirect.mayoclinicmsg.org
- https://fhir4.healow.com/fhir/r4/AHBJBD
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 and National Provider Directory roles.
-
dba WinnMed Mabel Clinic
- Primary Care Clinic/Center
- Mabel, MN
- NPI 1093857393
-
dba WinnMed Decorah Clinic
- Multi-Specialty Clinic/Center
- Decorah, IA
- NPI 1992854863
-
- Cardiovascular Disease Physician
- West Des Moines, IA
- NPI 1164410932
-
- Obstetrics & Gynecology Physician
- Houston, TX
- NPI 1740384908
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba MercyOne Oelwein Medical Center
- Critical Access Hospital
- Oelwein, IA
- NPI 1528009511
-
dba Gundersen Palmer Lutheran Hospital and Clinics
- Critical Access Hospital
- West Union, IA
- NPI 1598765398
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132358400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613433600000",
"number": "1770565186",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "901 MONTGOMERY ST",
"city": "DECORAH",
"state": "IA",
"postal_code": "521012325",
"telephone_number": "563-382-2911",
"fax_number": "563-382-4143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "901 MONTGOMERY ST",
"city": "DECORAH",
"state": "IA",
"postal_code": "521012325",
"telephone_number": "563-382-2911",
"fax_number": "563-382-4143"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOUDRY",
"first_name": "ERICKA",
"middle_name": "ROSE",
"name_prefix": "Mrs.",
"credential": "P.A.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-11-19",
"last_updated": "2021-02-16",
"certification_date": "2021-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "IA",
"license": "001593",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "emoudry595436@ehrdirect.mayoclinicmsg.org",
"affiliation": "N",
"address_1": "901 Montgomery St",
"city": "Decorah",
"state": "IA",
"country_code": "US",
"postal_code": "521012325",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "ERICKA",
"last_name": "MRACEK",
"middle_name": "ROSE",
"credential": "PA",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Decorah, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.