NPIMap

Individual provider Active NPI

Charles A Moore, MD

  • Internal Medicine Physician
  • Middlesboro, KY
National Provider Identifier
1003816372
Registry record updated Apr 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
22757 Issued in KY
Practice address
123 N 19TH St
Suite 201
Middlesboro, KY 40965-2865
Phone
(606) 248-0090
Fax
(606) 248-8803
NPI assigned
Jul 28, 2005
Last updated
Apr 27, 2010By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 27, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 22757 KY Primary

Addresses

Primary practice location

123 N 19TH St
Suite 201
Middlesboro, KY 40965-2865

Mailing address

PO Box 309
Middlesboro, KY 40965-0309
Phone (606) 248-0090

Other identifiers 13

IdentifierTypeStateIssuer
1635649000OtherKYDEPARTMENT OF LABOR
017423400OtherKYBLACK LUNG
1326780OtherKYUMWA
64227572MedicaidKY
000051203OtherTNBLUE CROSS OF TENNESSEE
000000062741OtherKYBLUE CROSS OF KY
1143OtherKYCHA
000000251586OtherVABLUE CROSS OF VA
006064205OtherVAVA MEDICAID
4176527OtherTNTENNESSE MEDICAID
1003816372MedicaidKY
110196198OtherKYRAIL ROAD MEDICARE
1659551935OtherKYMEDICARE GROUP NPI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, TN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040226000049 KY Practitioner - Internal Medicine 6901791409 Reassigns benefits to 2 organizations
Receives reassigned benefits from 1 practitioner
Practice locations: Middlesboro, KY; Pineville, KY
I20100628000414 TN Practitioner - Internal Medicine 6901791409 Practice locations: Harrogate, TN

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Louisville School of Medicine, 1985
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Cardinal Health PLLCGroup PAC ID 3375011968, 9 clinicians

Practice addresses (Care Compare)

123 N 19TH St
Middlesboro, KY 40965-2865

2004 Cumberland Ave
Suite 100
Middlesboro, KY 40965-1385
Phone (606) 248-3015

235 New Wilson Lane
Middlesboro, KY 40965
Phone (606) 248-0925

3600 Cumberland Ave
Middlesboro, KY 40965-2614
Phone (606) 242-1100

504 S 24TH St
Middlesboro, KY 40965-1447
Phone (606) 248-1540

9600 Lamborne Blvd
Louisville, KY 40272-2505
Phone (385) 207-9919

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.15 of 100Reported as apm
Quality
47.14
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
22757KYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Appalachian Regional Healthcare, Inc. CurrentSince Oct 1, 2020 Accepting new patients
Charles a Moore CurrentSince Nov 15, 2003 Accepting new patients
Appalachian Regional Healthcare, Inc CurrentSince Oct 1, 2020 Accepting new patients
Appalachian Regional Healthcare, Inc Current Accepting new patients
Downtown Radiology Inc CurrentSince May 23, 2007 Accepting new patients
Harrogate Health Group LLC Past Accepting new patients
Middlesboro Operations, LLC Past Accepting new patients
Hanging Rock LTC, LLC Past Accepting new patients
Appalachian Regional Healthcare, Inc. Past Accepting new patients
Middlesborough Emergency Physicians LLC Past Accepting new patients

Locations

37 Ball Park Rd
Harlan, KY 40831
Phone (606) 263-3900

123 N 19th St
Middlesboro, KY 40965
Phone (606) 248-0090

123 N 19th St
Ste 201
Middlesboro, KY 40965
Phone (606) 248-0090

2004 Cumberland Ave
Ste 100
Middlesboro, KY 40965
Phone (606) 248-3015

3600 Cumberland Ave
Middlesboro, KY 40965
Phone (606) 237-1700

Interoperability endpoints

  • Direct secure messaging: charles.moore.1@11792.direct.athenahealth.com
  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Mountain View Nursing and Rehabilitation CenterPineville, KY, CCN 185243 Skilled nursing facility Adp of the SNF Sep 1, 2020

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1272326400000",
    "number": "1003816372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 309",
            "city": "MIDDLESBORO",
            "state": "KY",
            "postal_code": "409650309",
            "telephone_number": "606-248-0090",
            "fax_number": "606-248-8803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 N 19TH ST",
            "address_2": "SUITE 201",
            "city": "MIDDLESBORO",
            "state": "KY",
            "postal_code": "409652865",
            "telephone_number": "606-248-0090",
            "fax_number": "606-248-8803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "CHARLES",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-28",
        "last_updated": "2010-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "22757",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF LABOR",
            "identifier": "1635649000",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLACK LUNG",
            "identifier": "017423400",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UMWA",
            "identifier": "1326780",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64227572",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF TENNESSEE",
            "identifier": "000051203",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF KY",
            "identifier": "000000062741",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHA",
            "identifier": "1143",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF VA",
            "identifier": "000000251586",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VA MEDICAID",
            "identifier": "006064205",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TENNESSE MEDICAID",
            "identifier": "4176527",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003816372",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "110196198",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NPI",
            "identifier": "1659551935",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Middlesboro, KY

Sources for this page

Verify at the official NPI Registry.