Active NPI
Jeffrey L Moffat, MD
- Family Medicine Physician
- Show Low, AZ
National Provider Identifier
1962469783
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 36459
- Practice address
- 1500 S White Mountain Rd Ste 300
Show Low, AZ 85901-7115 - Phone
- (928) 532-5838
- Fax
- (928) 532-6670
- NPI assigned
- Apr 26, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 36459 | AZ | Primary |
| Family Medicine Physician | 207Q00000X | 18705 | AZ |
Addresses
Primary practice location
1500 S White Mountain Rd Ste 300
Show Low, AZ 85901-7115
Mailing address
1500 S White Mountain Rd Ste 300
Show Low, AZ 85901-7115
Phone (928) 532-5838
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 286387 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060301000698 | AZ | Practitioner - Family Practice | 2163314725 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- University of Oklahoma College of Medicine, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Changepoint Integrated Health
Practice addresses (Care Compare)
1015 E 2ND St
Winslow, AZ 86047-4125
Phone (928) 289-4658
1801 W Deuce of Clubs
Suite 100
Show Low, AZ 85901-2704
Phone 92853753157726
Hospital & facility affiliations
- Summit Healthcare Home Health
- Summit Healthcare Regional Medical Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
| Removal of skin lesions | 1-10 |
| Removal or shaving of skin growth | 1-10 |
| Skin biopsy | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18705 | AZ | MD | Family Medicine Physician |
| 36459 | AZ | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Changepoint Integrated Health | Past | Accepting new patients | |
| White Mountain Emergency Physicians, PC | Past | Accepting new patients | |
| Bornstein Medical PLLC | Family Medicine | Past | Accepting new patients |
Organizations & group practices 5
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Holbrook, AZ
- NPI 1205877610
AZ
-
- Mental Illness Community Based Residential Treatment Facility
- Lakeside, AZ
- NPI 1467783118
-
- Community/Behavioral Health Agency
- Show Low, AZ
- NPI 1518202100
-
- Emergency Medicine Physician
- Show Low, AZ
- NPI 1710964101
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Show Low, AZ
- NPI 1134199839
-
- Rural Health Clinic/Center
- Overgaard, AZ
- NPI 1770700767
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680134400000",
"number": "1962469783",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 S WHITE MOUNTAIN RD STE 300",
"city": "SHOW LOW",
"state": "AZ",
"postal_code": "859017115",
"telephone_number": "928-532-5838",
"fax_number": "928-532-6670"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 S WHITE MOUNTAIN RD STE 300",
"city": "SHOW LOW",
"state": "AZ",
"postal_code": "859017115",
"telephone_number": "928-532-5838",
"fax_number": "928-532-6670"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOFFAT",
"first_name": "JEFFREY",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-26",
"last_updated": "2023-03-30",
"certification_date": "2023-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AZ",
"license": "36459",
"primary": true
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AZ",
"license": "18705",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "286387",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Show Low, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.