Victoria A Moore, PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA10003474 Issued in WA

Practice address

209 Lilly Rd NE
Olympia, WA 98506-5197

Phone

(360) 413-8250

Fax

(360) 413-8830

NPI assigned

Nov 9, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gastroenterology Associates Clinical Practice, PLLC

  dba Gastroenterology Associates

  • Gastroenterology Physician
  • Olympia, WA
  • NPI 1811556442
  Medicare reassignment
• Puget Sound Gastroenterology, PLLC

  dba PSG Division of Pathology

  • Clinical Medical Laboratory
  • Lynnwood, WA
  • NPI 1689646838
  Medicare reassignment
• Puget Sound Gastroenterology, PLLC

  • Gastroenterology Physician
  • Olympia, WA
  • NPI 1386340164
  NPD
• Puget Sound Gastroenterology, PLLC

  dba Puget Sound Gastroenterology at Kirkland

  • Gastroenterology Physician
  • Kirkland, WA
  • NPI 1427185388
  NPD
• Lake Washington Anesthesia PLLC

  • Certified Registered Nurse Anesthetist
  • Kirkland, WA
  • NPI 1962935197
  NPD (past)
• Cellnetix Pathology, PLLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Tucson, AZ
  • NPI 1598624207
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1912988650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 LILLY RD NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065197",
            "telephone_number": "360-413-8250",
            "fax_number": "360-413-8830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 LILLY RD NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065197",
            "telephone_number": "360-413-8250",
            "fax_number": "360-413-8830"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 Lilly Rd NE",
            "address_2": "suite 204",
            "address_purpose": "LOCATION",
            "city": "Olympia",
            "state": "WA",
            "postal_code": "985065195",
            "country_code": "US",
            "telephone_number": "360-413-8250",
            "fax_number": "360-413-8830",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "VICTORIA",
        "middle_name": "A",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-09",
        "last_updated": "2023-03-07",
        "certification_date": "2021-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10003474",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA LISENCE",
            "identifier": "PA10003474",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robin Elizabeth Moore
• Samantha Moore, PA-C
• Sarah Moore
• Sarah E Moore, MA, LMHCA
• Scott David Moore, D.C.
• Brittany Megan Moores, MSPO, LCPO, CPO
• Sylvia Morales-Bronner, MD
• Raymark Layda Morales, MSW, LICSW
• Danielle Moran
• Laura K Moran, AUD

• Medical Physician Assistant in Olympia, WA
• Providers in Olympia, WA by specialty
• Medical Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.