Debora Marie Moore, PA C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA53892 Issued in CA

Practice address

116 S Palisade Dr Ste 210
Santa Maria, CA 93454-8906

Phone

(805) 934-2488

Fax

(805) 934-2480

NPI assigned

Aug 26, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Debora Moellenberndt Former name

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Physician Assistant

Education

Other, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Thomas M Dawes Jr MD a Medical Corporation

  • Family Medicine Physician
  • Santa Maria, CA
  • NPI 1891824496

  CA

  Medicare reassignment
• Decatur General Hospital

  • Psychiatric Hospital Unit
  • Decatur, AL
  • NPI 1326288770
  NPD (past)

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

{
    "created_epoch": "1125014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679529600000",
    "number": "1992798706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 S PALISADE DR STE 210",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934548906",
            "telephone_number": "805-934-2488",
            "fax_number": "805-934-2480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 S PALISADE DR STE 210",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934548906",
            "telephone_number": "805-934-2488",
            "fax_number": "805-934-2480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "DEBORA",
        "middle_name": "MARIE",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-26",
        "last_updated": "2023-03-23",
        "certification_date": "2023-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AL",
            "license": "PA.966",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "101190",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA53892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEBORA",
            "last_name": "MOELLENBERNDT",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cristina Montes, LMFT
• Jasmine Guadalupe Montes
• Vincent Montes
• Kayla Michelle Montoya
• Amanda Moon-Bernal
• Johanna Baran Moore, MD
• Joshua Moore, PT
• Katrina Lee Moore
• Mariah Moore
• Samuel David Moore, O.D.

• All providers in Santa Maria, CA
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 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.

Verify at the official NPI Registry.