Individual provider Active NPI

Ann Moore, COTA

  • Occupational Therapy Assistant
  • Virginia Beach, VA
National Provider Identifier
1043469208
Registry record updated Nov 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
233366 Issued in VA
Practice address
6401 Auburn Dr
Virginia Beach, VA 23464-3601
Phone
(757) 420-1485
NPI assigned
Sep 12, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 6, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 233366 VA Primary

Addresses

Primary practice location

6401 Auburn Dr
Virginia Beach, VA 23464-3601

Mailing address

6401 Auburn Dr
Virginia Beach, VA 23464-3601
Phone (757) 420-1485

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220809004056 VA Practitioner - Occupational Therapist in Private Practice 6406239391 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Healthcare Services IncGroup PAC ID 2163339722, 3,431 clinicians

Practice addresses (Care Compare)

1853 Old Donation Pkwy
Virginia Beach, VA 23454-3004
Phone (757) 412-1380

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
233366VAMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Healthcare Services Inc CurrentSince Apr 19, 2022 Accepting new patients
Legacy Healthcare Services Inc CurrentSince Apr 19, 2022 Accepting new patients

Locations

110 Horizon Dr
#310
Raleigh, NC 27615

3365 Ogden Rd
Roanoke, VA 24018
Phone (540) 682-7500

1853 Old Donation Pkwy
Virginia Beach, VA 23454
Phone (757) 412-1180

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1221177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446768000000",
    "number": "1043469208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6401 AUBURN DR",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234643601",
            "telephone_number": "757-420-1485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6401 AUBURN DR",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234643601",
            "telephone_number": "757-420-1485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "ANN",
        "credential": "COTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-09-12",
        "last_updated": "2015-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "VA",
            "license": "233366",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.