Individual provider Active NPI

Moses Minsung Chung

  • Physician Assistant
  • Beavercreek, OH
National Provider Identifier
1861227548
Registry record updated Feb 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
3095 Dayton Xenia Rd Ste 100
Beavercreek, OH 45434-4310
Phone
(937) 531-7902
Fax
(937) 531-7904
NPI assigned
Sep 3, 2024
Last updated
Feb 27, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 27, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

3095 Dayton Xenia Rd Ste 100
Beavercreek, OH 45434-4310

Mailing address

1 Prestige PL Ste 550
Miamisburg, OH 45342-6115
Phone (937) 762-1310

Other practice location 1

4100 W 3rd St
Dayton, OH 45428-9000
Phone (937) 268-6511

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/
Direct Messaging Address mchung890477@direct.ketteringhealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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 1

Enrollment IDStateProvider typePAC IDDetails
I20241219001817 OH Practitioner - Physician Assistant 0749717478 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Alliance Physicians IncGroup PAC ID 0840104360, 314 clinicians

Practice addresses (Care Compare)

1625 S Alex Rd
West Carrollton, OH 45449-5404
Phone (937) 865-0534

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Physicians Inc CurrentSince Feb 1, 2025 Accepting new patients
Alliance Physicians Inc CurrentSince Feb 1, 2025 Accepting new patients

Locations

3095 Dayton Xenia Rd
Ste 100
Dayton, OH 45434
Phone (937) 458-4200

7740 Washington Village Dr
Ste 130
Dayton, OH 45459
Phone (513) 932-4891

1 Prestige Pl
Ste 550
Miamisburg, OH 45342
Phone (937) 762-1306

1625 S Alex Rd
West Carrollton, OH 45449
Phone (937) 865-0534

Interoperability endpoints

  • Direct secure messaging: mchung890477@direct.ketteringhealth.org

Organizations & group practices 2

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": "1725321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740614400000",
    "number": "1861227548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PRESTIGE PL STE 550",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453426115",
            "telephone_number": "937-762-1310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3095 DAYTON XENIA RD STE 100",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454344310",
            "telephone_number": "937-531-7902",
            "fax_number": "937-531-7904"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4100 W 3rd St",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454289000",
            "country_code": "US",
            "telephone_number": "937-268-6511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHUNG",
        "first_name": "MOSES",
        "middle_name": "MINSUNG",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-09-03",
        "last_updated": "2025-02-27",
        "certification_date": "2025-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "3095 Dayton Xenia Rd Ste 100",
            "city": "Beavercreek",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454344310",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mchung890477@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "3095 Dayton Xenia Rd Ste 100",
            "city": "Beavercreek",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454344310",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Beavercreek, OH

Sources for this page

Verify at the official NPI Registry.