Active NPI
Amber Moulton-Mister, PA-C
- Physician Assistant
- Portland, OR
National Provider Identifier
1861432163
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 159703
- Practice address
- 2448 SE 89TH Ave
Suite 1
Portland, OR 97216-2052 - Phone
- (503) 788-6483
- Fax
- (503) 772-7914
- NPI assigned
- Jun 7, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 004679 | GA | |
| Physician Assistant | 363A00000X | 2010-0006 | NM | |
| Physician Assistant | 363A00000X | 159703 | OR | Primary |
Addresses
Primary practice location
2448 SE 89TH Ave
Suite 1
Portland, OR 97216-2052
Mailing address
2448 SE 89TH Ave
Suite 1
Portland, OR 97216-2052
Phone (503) 788-6483
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 499847420A | Medicaid | GA | |
| 97WCHDK | Other | GA | MEDICARE-TYPE UNSPECIFIED |
| 500652768 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004679 | GA | MD | Physician Assistant |
| 2010-0006 | NM | MD | Physician Assistant |
| 159703 | OR | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432166400000",
"number": "1861432163",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2448 SE 89TH AVE",
"address_2": "SUITE 1",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972162052",
"telephone_number": "503-788-6483",
"fax_number": "503-772-7914"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2448 SE 89TH AVE",
"address_2": "SUITE 1",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972162052",
"telephone_number": "503-788-6483",
"fax_number": "503-772-7914"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOULTON-MISTER",
"first_name": "AMBER",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-07",
"last_updated": "2015-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "004679",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NM",
"license": "2010-0006",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OR",
"license": "159703",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "499847420A",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE-TYPE UNSPECIFIED",
"identifier": "97WCHDK",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500652768",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.