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

Johnathan M Moore, PA

Individual provider Physician Assistant · NPI 1467112250

Johnathan M Moore, PA is a Physician Assistant in Danielson, Connecticut. Qualified in 2022, 4 years ago. Practices with Day Kimball Medical Group Inc, a 91-clinician group, works from 2 locations and accepts Medicare assignment.

Years since qualifying
4
In the registry since
2021
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

55 Green Hollow Rd
Danielson, CT 06239-3533
Phone: (860) 779-1865
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 900 Washington Rd, West Point, NY 10996-1109 — (845) 938-0482

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1467112250
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedDecember 21, 2021
Last updated in NPPESAugust 23, 2022
Certification dateAugust 23, 2022
Mailing address325 N James St Apt 2, Peekskill, NY 10566-2486

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Day Kimball Medical Group Inc — 91 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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