Individual provider Active NPI

Judson Ramsay Moore, P.A.

  • Surgical Physician Assistant
  • Bellingham, WA
National Provider Identifier
1871773028
Registry record updated Nov 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA60056503 Issued in WA
Practice address
3015 Squalicum Pkwy
Suite 200
Bellingham, WA 98225-1945
Phone
(360) 733-2092
Fax
(360) 733-4013
NPI assigned
Nov 5, 2007
Last updated
Nov 19, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA60056503 WA Primary

Addresses

Primary practice location

3015 Squalicum Pkwy
Suite 200
Bellingham, WA 98225-1945

Mailing address

PO Box 5096
Bellingham, WA 98227-5096
Phone (360) 733-2092

Other identifiers 4

IdentifierTypeStateIssuer
6811MOOtherWAREGENCE
9320439OtherWAAETNA
1871773028MedicaidWA
0243488OtherWAL&I AND CRIME VICTIMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20090116000234 WA Practitioner - Physician Assistant 4789747718 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
PeacehealthGroup PAC ID 9537073960, 292 clinicians

Practice addresses (Care Compare)

2901 Sqaulicum Pkwy
Bellingham, WA 98225-1851
Phone (360) 788-9373

3015 Squalicum Pkwy
Bellingham, WA 98225-1906

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Peacehealth CurrentSince Dec 3, 2008 Accepting new patients

Locations

2901 Squalicum Pkwy
Bellingham, WA 98225
Phone (360) 734-5400

3015 Squalicum Pkwy
Ste 100
Bellingham, WA 98225
Phone (360) 715-4186

3015 Squalicum Pkwy
Ste 200
Bellingham, WA 98225
Phone (360) 733-2092

835 E Fairhaven Ave
Burlington, WA 98233
Phone (360) 755-0641

1115 SE 164th Ave
Dept 358
Vancouver, WA 98683
Phone (360) 729-1253

Interoperability endpoints

  • Direct secure messaging: jmoore10140@direct.peacehealth.org

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, 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": "1194220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290124800000",
    "number": "1871773028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5096",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982275096",
            "telephone_number": "360-733-2092",
            "fax_number": "360-733-4013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3015 SQUALICUM PKWY",
            "address_2": "SUITE 200",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982251945",
            "telephone_number": "360-733-2092",
            "fax_number": "360-733-4013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "JUDSON",
        "middle_name": "RAMSAY",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-05",
        "last_updated": "2010-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA60056503",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "6811MO",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9320439",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1871773028",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I AND CRIME VICTIMS",
            "identifier": "0243488",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellingham, WA

Sources for this page

Verify at the official NPI Registry.