Juanita A Moore, PHYSICIAN ASSISTANT
Individual provider Active NPI Medical Physician Assistant · Rancho Mirage, CA
NPI 1881920007 · NPPES record last updated Dec 14, 2015
Key facts
- NPI
- 1881920007
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- PA20555 (CA)
- Practice address
- 39000 Bob Hope Dr
Emergency Department
Rancho Mirage, CA 92270-3221 - Phone
- (760) 773-1221
- NPI assigned
- Oct 22, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Carbon Health Medical Group of California PC
Practice addresses (Care Compare)
3955 Bedford Canyon Rd
Unit 103
Corona, CA 92883-3627
Phone (951) 293-4722
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100114000606 | CA | Practitioner - Physician Assistant | 0547302440 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20555 | CA | MD | Public Health & General Preventive Medicine Physician |
| PA20555 | CA | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Orange County Urgent Care #3, Inc. | Current |
Accepting new patients | |
| Cep America - California | Current |
Accepting new patients | |
| Emergency Physicians Medical Group, Inc | Past | Accepting new patients | |
| Eisenhower Medical Center | Past | Accepting new patients | |
| Emergency Medicine Physician Partners of Rancho Mirage, Inc | Past | Accepting new patients | |
| Carbon Health Primary Care of California PC | Past |
Accepting new patients |
Locations
82151 Avenue 42
Ste 100
Indio, CA 92203
Phone (442) 215-1320
78965 Highway 111
Ste 100
La Quinta, CA 92253
Phone (706) 777-7847
1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423
1150 N Indian Canyon Dr
Palm Springs, CA 92262
Phone (760) 323-6251
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA20555 | CA | Yes |
Addresses
Primary practice location
39000 Bob Hope Dr
Emergency Department
Rancho Mirage, CA 92270-3221
Mailing address
39000 Bob Hope Dr
Emergency Department
Rancho Mirage, CA 92270-3221
Phone (760) 773-1221
Other providers in Rancho Mirage, CA
- Monterey OBGYN Medical Group Inc
- Victor Manuel Montes
- Jessica Mylene Anoucha Monthe Fossi
- Carolina Montoya
- Ramona A. Moody French
- Bhagwan Moorjani
- Inayat M Moosa
- Soroush Moradi
- Carlos Alfonso Morales-Chinchillas
- Genaro Morales
All providers in Rancho Mirage, CA · Medical Physician Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 14, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.