Active NPI
Charles Moore, M.D.
- Emergency Medicine Physician
- Kalamazoo, MI
National Provider Identifier
1013969500
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 4301038198
- Practice address
- 1535 Gull Rd
MSB 015
Kalamazoo, MI 49048-1650 - Phone
- (269) 226-6933
- Fax
- (269) 226-6949
- NPI assigned
- May 16, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 4301038198 | MI | Primary |
Addresses
Primary practice location
1535 Gull Rd
MSB 015
Kalamazoo, MI 49048-1650
Mailing address
1535 Gull Rd
MSB 015
Kalamazoo, MI 49048-1650
Phone (269) 226-6933
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G56008127 | Other | MI | MEDICARE - THREE RIVERS |
| CM038198 | Other | MI | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kalamazoo Acute Care Specialists PLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Emergency Medical Services (Emergency Medicine) Physician
- Kalamazoo, MI
- NPI 1366897670
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204588800000",
"number": "1013969500",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1535 GULL RD",
"address_2": "MSB 015",
"city": "KALAMAZOO",
"state": "MI",
"postal_code": "490481650",
"telephone_number": "269-226-6933",
"fax_number": "269-226-6949"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1535 GULL RD",
"address_2": "MSB 015",
"city": "KALAMAZOO",
"state": "MI",
"postal_code": "490481650",
"telephone_number": "269-226-6933",
"fax_number": "269-226-6949"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "CHARLES",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-16",
"last_updated": "2008-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "MI",
"license": "4301038198",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE - THREE RIVERS",
"identifier": "G56008127",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "CM038198",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kalamazoo, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.