Edward M Moore, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

MD048178L Issued in PA

Practice address

561 Fairthorne Ave
Philadelphia, PA 19128-2412

Phone

(215) 487-4071

Fax

(215) 483-8187

NPI assigned

Sep 28, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Networks

• devoted network organization-598bd2d4-c652-473f-ba7a-132f674c8eb6
• OH PPO
• devoted network organization-8ee96498-f86e-45f6-9fc9-a0f06c1636f9
• devoted network organization-2d523d8e-e8f9-454a-bcd3-333df65bdbe8
• devoted network organization-9f3dfbd3-4aa6-4c92-8e71-9c4ed35ce037

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.

• Eastern Pennsylvania Physician Alliance LLC

  • Neurology Physician
  • Clarion, PA
  • NPI 1902440621
  Medicare reassignment NPD
• The Behavioral Wellness Center at Girard

  • Methadone Clinic
  • Philadelphia, PA
  • NPI 1598798928
  NPD (past)
• Camden County Health Services Center

  • Psychiatric Hospital
  • Blackwood, NJ
  • NPI 1578559340
  NPD (past)

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013009216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GOLF VIEW DR",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080431428",
            "telephone_number": "856-795-5114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "561 FAIRTHORNE AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191282412",
            "telephone_number": "215-487-4071",
            "fax_number": "215-483-8187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "EDWARD",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "PA",
            "license": "MD048178L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001571971",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Derek Moore
• Derik Moore
• Derrick Moore
• Dwayne E Moore, MA OF BUSINESS ADMIN
• Edward B Moore Jr.
• Eric Moore, PHD
• Erica Moore, DVM
• Fazia T Moore
• Frances Moore, P.T.
• Gina Diana Moore, MPT

• Psychiatry Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Psychiatry Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.