JACOB MOORE (NPI# 1851780928) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851780928 |
| Entity Type | Individual |
| Full Name | JACOB MOORE |
| Credential | PA-C |
| Practice Address |
1900 Silver Lake Rd Nw Suite 110 New Brighton MN 55112-1786 |
| Practice Telephone | 6516289566 |
| Practice Fax Number | 6516280411 |
| Mailing Telephone | 6516289566 |
| Mailing Fax Number | 6516280411 |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2015-04-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | MN | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154617058 | Jacob E Moore | Emergency Medicine | 2326 N Lincoln Park W Apt 4b, Chicago, IL 60614-3446 | 2011-06-20 |
| 1043459175 | Jacob B Moore | Physical Medicine & Rehabilitation | 2707 Stange Road Suite 102, Mcfarland Clinic PC, Ames, IA 50010-3014 | 2009-02-12 |
| 1144249277 | Jacob Jackson Moore | Ophthalmology | 900 Morgan Ave, Corpus Christi, TX 78404-2028 | 2006-07-19 |
| 1831719947 | Jacob Ryan Moore | Student in an Organized Health Care Education/Training Program | 2100 Stantonsburg Rd, Greenville, NC 27834-2818 | 2020-04-17 |
| 1497384424 | Jacob Aaron Moore | Nurse Practitioner | 800 Rose St, Lexington, KY 40536-7001 | 2020-04-02 |
| 1255892287 | Jacob James Moore | Psychiatry & Neurology | 155 N Fresno St, Fresno, CA 93701-2302 | 2019-03-31 |
| 1336644723 | Jacob Clark Moore | Student in an Organized Health Care Education/Training Program | 250 Park St, Bowling Green, KY 42101-1760 | 2018-03-27 |
| 1821512179 | Jacob Moore | Specialist/Technologist | 116 Ward Sports Medicine Building, Greenville, NC 27858 | 2017-07-28 |
| 1588027007 | Jacob Moore | Pharmacist | 1745 Quentin Rd, Lebanon, PA 17042-7435 | 2016-04-01 |
| 1750762928 | Jacob Robert Moore | Emergency Medicine | 5841 S Maryland Ave Rm L539, Chicago, IL 60637-1447 | 2015-06-14 |
| Street Address |
1900 SILVER LAKE RD NW SUITE 110 |
| City | NEW BRIGHTON |
| State | MN |
| Zip Code | 55112-1786 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861492134 | Edwin Walker | Psychiatry & Neurology | 1900 Silver Lake Rd Nw, New Brighton, MN 55112-1786 | 2005-07-28 |
| 1144833484 | Anna Marie Ricci | Counselor | 1900 Silver Lake Rd Nw, New Brighton, MN 55112-1786 | 2020-08-26 |
| 1568086346 | Kenneth Leroy King Sr. | Student in an Organized Health Care Education/Training Program | 1900 Silver Lake Rd Nw, New Brighton, MN 55112-1786 | 2020-06-08 |
| 1184247108 | Alissa Marie Lambrides | Counselor | 1900 Silver Lake Rd Nw, New Brighton, MN 55112-1786 | 2020-05-26 |
| 1184247660 | Tammie Leetta Fullman | Counselor | 1900 Silver Lake Rd Nw, New Brighton, MN 55112-1786 | 2020-05-19 |
| 1396379541 | Meredith Lawlor | Counselor | 1900 Silver Lake Rd Nw, New Brighton, MN 55112-1786 | 2020-02-26 |
| 1154961225 | Ryan Jones | Counselor | 1900 Silver Lake Rd Nw, New Brighton, MN 55112-1786 | 2020-01-07 |
| 1902440944 | Olufemi Michael Adetunji | Nurse Practitioner | 1900 Silver Lake Rd Nw, New Brighton, MN 55112-1786 | 2019-11-02 |
| 1174166672 | Williametta Augusta Wells | Counselor | 1900 Silver Lake Rd Nw, New Brighton, MN 55112-1786 | 2019-10-28 |
| 1780227736 | Jason T Caspillo | Psychologist | 1900 Silver Lake Rd Nw, New Brighton, MN 55112-1786 | 2019-10-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932729704 | Owegio Wreh | Technician | 1405 Silver Lake Road Suite 15, New Brighton, MN 55112 | 2020-04-22 |
| 1205497435 | Silver Lake Smiles Family Dentistry | Clinic/Center | 2370 Palmer Drive, New Brighton, MN 55112 | 2019-06-27 |
| 1932766169 | Matthew Thomas Hanowski | Dentist | 2442 Mounds View Boulevard, Mounds View, MN 55112 | 2019-05-22 |
| 1437619988 | Marjean Diane Leary | Registered Nurse | 338 New Brighton Road, Apt, Suite, Bldg. (optional), New Brighton, MN 55112 | 2019-03-21 |
| 1558802728 | Krishna Katira | Student in an Organized Health Care Education/Training Program | 2442 County Hwy 10, Mounds View, MN 55112 | 2017-03-20 |
| 1245781608 | Evan Fredrick Lieberman | Counselor | 1900 Silver Lake Rd, Suite 110, New Brighton, MN 55112 | 2016-10-20 |
| 1093262065 | Ryan Zinken | Nurse Practitioner | 1900 Silver Lake Road, Suite 110, New Brighton, MN 55112 | 2016-09-07 |
| 1447703228 | Alison Glodek | Social Worker | 2543 17th St Nw, New Brighton, MN 55112 | 2016-07-28 |
| 1659728194 | Ge Vang Sr. | Driver | 2160 County Road E West #205, 2160 County Road E West #205, New Brighton, MN 55112 | 2016-05-14 |
| 1114373578 | Jessica Gapinski | Specialist/Technologist | 3900 Bethel Drive, Arden Hills, MN 55112 | 2016-05-04 |
| Find all providers in zip 55112 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033673058 | Amanda Drewek | Physician Assistant | 1900 Silver Lake Rd Nw Ste 110, New Brighton, MN 55112-1789 | 2019-01-23 |
| 1255889689 | Polly Hendel | Physician Assistant | 1900 Silver Lake Rd Nw Ste 110, New Brighton, MN 55112-1789 | 2016-09-14 |
| 1982093449 | Annette Lerew-zimanski | Physician Assistant | 1900 Silver Lake Rd Nw, New Brighton, MN 55112-1786 | 2015-01-21 |
| 1790086411 | Laura K Stanz | Physician Assistant | 1151 Silver Lake Rd Nw, New Brighton, MN 55112-6324 | 2010-11-11 |
| 1457688244 | Jaclyn Schloesser | Physician Assistant | 1900 Silver Lake Rd Nw, Suite 110, New Brighton, MN 55112-1786 | 2009-11-16 |
| 1043419450 | Lindsey K Locken | Physician Assistant | 1151 Silver Lake Rd Nw, New Brighton, MN 55112-6324 | 2007-07-16 |
| 1194743203 | Sarah Mae Anikpo | Physician Assistant | 1900 Silver Lake Rd Nw, Suite 110, New Brighton, MN 55112-1786 | 2006-07-17 |
| 1356375679 | Veronica Lee Valencourt | Physician Assistant | 1900 Silver Lake Rd Nw, Suite 110, New Brighton, MN 55112-1786 | 2006-07-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588265284 | Foua Vang | Physician Assistant | 689 County Road D E Apt 302, Saint Paul, MN 55117-1263 | 2020-11-08 |
| 1043811870 | Leiah Hoffman | Physician Assistant | 4243 Timberridge Ln Apt A, Hermantown, MN 55811-4047 | 2020-11-06 |
| 1760083059 | Amanda Hanover | Physician Assistant | 10346 Mississippi Blvd Nw, Coon Rapids, MN 55433-4521 | 2020-11-04 |
| 1780284844 | Lily Ganz | Physician Assistant | 2737 Huntington Ave, St Louis Park, MN 55416-3917 | 2020-10-28 |
| 1972103000 | Jaclyn Ann Bautch | Physician Assistant | 24721 State Highway 15, Saint Augusta, MN 56301-9211 | 2020-10-28 |
| 1801496047 | Tanner Vaughn Kramp | Physician Assistant | 3450 Wild Turkey Rd, Red Wing, MN 55066-1762 | 2020-10-27 |
| 1497354955 | Sarah Marti | Physician Assistant | 810 Thornton St Se Apt 904, Minneapolis, MN 55414-3652 | 2020-10-25 |
| 1598364473 | Kylee N Persing | Physician Assistant | 10 4th Ave S, Saint Cloud, MN 56301-3614 | 2020-10-21 |
| 1073112009 | Reece Edward Mcevoy | Physician Assistant | 2638 Sand Trap Rd Se, Rochester, MN 55904-3904 | 2020-10-21 |
| 1679189021 | Anne Elizabeth Drabot | Physician Assistant | 4741 Vincent Ave S, Minneapolis, MN 55410-1843 | 2020-09-21 |
| Find all providers with the same taxonomy | ||||
| City | NEW BRIGHTON |
| Zip Code | 55112 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.