Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jacob Moore, PA-C

Individual provider Physician Assistant · NPI 1851780928

Jacob Moore, PA-C is a Physician Assistant in New Brighton, Minnesota. Qualified in 2014, 12 years ago. Practices with Nystrom and Associates Ltd, a 617-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Minnesota.

Years since qualifying
12
Licensed in
MN
In the registry since
2015
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1900 Silver Lake Rd NW Ste 110
New Brighton, MN 55112-1786
Phone: (651) 628-9566
Fax: (651) 628-0411
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X (MN)

Record details

NPI number1851780928
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJanuary 13, 2015
Last updated in NPPESApril 27, 2015
Mailing address1900 Silver Lake Rd Nw, Suite 110, New Brighton, MN 55112-1786

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Nystrom And Associates Ltd — 617 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

Other providers in New Brighton