Active NPI
Randall Evan Moss, PA-C
- Physician Assistant
- Silverdale, WA
National Provider Identifier
1912196221
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1125502
- Practice address
- 2050 Barb St
Silverdale, WA 98315 - Phone
- (360) 415-4347
- NPI assigned
- Oct 23, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1125502 | CA | Primary |
Addresses
Primary practice location
2050 Barb St
Silverdale, WA 98315
Mailing address
2050 Barb St
Silverdale, WA 98315
Phone (360) 415-4347
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1125502 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193097600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446076800000",
"number": "1912196221",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2050 BARB ST",
"city": "SILVERDALE",
"state": "WA",
"postal_code": "98315",
"telephone_number": "360-415-4347"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2050 BARB ST",
"city": "SILVERDALE",
"state": "WA",
"postal_code": "98315",
"telephone_number": "360-415-4347"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOSS",
"first_name": "RANDALL",
"middle_name": "EVAN",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-10-23",
"last_updated": "2015-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "1125502",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Silverdale, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 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.