NPIMap

Individual provider Active NPI

Douglas Bernard Moore, PA-C

  • Physician Assistant
  • Tacoma, WA
National Provider Identifier
1790853422
Registry record updated Jan 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA10005095 Issued in WA
Practice address
1304 Fawcett Ave
Suite 100
Tacoma, WA 98402-1911
Phone
(253) 761-4200
Fax
(253) 383-3553
NPI assigned
Dec 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA10005095 WA
Physician Assistant 363A00000X PA10005095 WA Primary

Addresses

Primary practice location

1304 Fawcett Ave
Suite 100
Tacoma, WA 98402-1911

Mailing address

PO Box 1535
Tacoma, WA 98401-1535
Phone (253) 761-4200

Other identifiers 8

IdentifierTypeStateIssuer
0215666OtherWALABOR AND INDUSTRIES-TRA
8862653OtherWAMEDICARE PIN-TRA KING
8943157OtherWALABOR AND INDUSTRIES CRIME VICTIMS-TRA
P00428602OtherWARR MEDICARE-TRA
8862652OtherWAMEDICARE PIN-TRA PIERCE
8862654OtherWAMEDICARE PIN-UNION AVENUE OPEN MRI
0249530OtherWALABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST
8951854OtherWALABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20070109000136 WA Practitioner - Physician Assistant 5294735668 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tra-Minw P SGroup PAC ID 2163316167, 152 clinicians

Practice addresses (Care Compare)

222 15TH Ave SE
Puyallup, WA 98372-3754
Phone (253) 841-4353

3402 S 18TH St
Tacoma, WA 98405-1903
Phone (253) 841-4353

34515 9TH Ave S
Federal Way, WA 98003-6761
Phone (253) 841-4353

407 14TH Ave SE
Puyallup, WA 98372-3770
Phone (253) 841-4353

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA10005095WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Imaging Northwest - Good Samaritan Hospital Imaging Alliance CurrentSince Mar 1, 2017 Accepting new patients
Tra Medical Imaging Centers LLC CurrentSince Dec 1, 2025 Accepting new patients
Tra-Minw P S CurrentSince Nov 5, 2015 Accepting new patients
Medical Imaging on 1St, LLC Past Accepting new patients

Locations

33915 1st Way S
Ste 130
Federal Way, WA 98003
Phone (253) 528-9135

34515 9th Ave S
Federal Way, WA 98003
Phone (253) 835-8100

9725 SE 36th St
Ste 114
Mercer Island, WA 98040

222 15th Ave SE
Puyallup, WA 98372

1304 Fawcett Ave
Ste 100
Tacoma, WA 98402
Phone (253) 680-3372

2502 S Union Ave
Tacoma, WA 98405
Phone (253) 759-5900

3402 S 18th St
Tacoma, WA 98405
Phone (253) 383-1099

315 S K St
Tacoma, WA 98405
Phone (253) 403-1291

Interoperability endpoints

  • FHIR API: https://app.meldrx.com/api/fhir/ei-trami

Organizations & group practices 6

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 8

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": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485820800000",
    "number": "1790853422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1535",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984011535",
            "telephone_number": "253-761-4200",
            "fax_number": "253-383-3553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1304 FAWCETT AVE",
            "address_2": "SUITE 100",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984021911",
            "telephone_number": "253-761-4200",
            "fax_number": "253-383-3553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "DOUGLAS",
        "middle_name": "BERNARD",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-01",
        "last_updated": "2017-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10005095",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA10005095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES-TRA",
            "identifier": "0215666",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN-TRA KING",
            "identifier": "8862653",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES CRIME VICTIMS-TRA",
            "identifier": "8943157",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE-TRA",
            "identifier": "P00428602",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN-TRA PIERCE",
            "identifier": "8862652",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN-UNION AVENUE OPEN MRI",
            "identifier": "8862654",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST",
            "identifier": "0249530",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST",
            "identifier": "8951854",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.