Individual provider Active NPI

Nicole Patricia Moore, NP

  • Acute Care Nurse Practitioner
  • Valley Stream, NY
National Provider Identifier
1043938392
Registry record updated Aug 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
432399 Issued in NY
Practice address
900 Franklin Ave
Valley Stream, NY 11580-2145
Phone
(516) 256-6000
NPI assigned
Aug 22, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine Registered Nurse 163WC0200X 695945 NY
Acute Care Nurse Practitioner 363LA2100X 432399 NY Primary

Addresses

Primary practice location

900 Franklin Ave
Valley Stream, NY 11580-2145

Mailing address

900 Franklin Ave
Valley Stream, NY 11580-2145
Phone (516) 256-6000

Other names 1

  • Nicole Patricia Williams Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230220001716 NY Practitioner - Nurse Practitioner 4082086095 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

301 E Main St
Bay Shore, NY 11706-8408
Phone (516) 734-8656

Hospital & facility affiliations

  • NS/Lij HS Southside Hospital Hospital, Bay Shore, NY, CCN 330043

Merit-based Incentive Payment System (MIPS)

Final score
79.07 of 100Reported as group
Quality
57.91
Promoting interoperability
77
Improvement activities
40
Cost
80.36

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
695945NYMDCritical Care Medicine Registered Nurse
432399NYMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore Health System Medical Faculty Group Practice Inc CurrentSince Jan 28, 2024 Accepting new patients

Locations

301 Montauk Hwy
Bay Shore, NY 11706
Phone (631) 630-3977

450 Lakeville Rd
North New Hyde Park, NY 11042
Phone (516) 321-3000

900 Franklin Ave
Valley Stream, NY 11580
Phone (516) 256-6000

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989

Interoperability endpoints

  • Direct secure messaging: nicolemoore@nslijmedgr.allscriptsdirect.net

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.

Hospital & facility affiliations 1

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": "1661126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661126400000",
    "number": "1043938392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 FRANKLIN AVE",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115802145",
            "telephone_number": "516-256-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 FRANKLIN AVE",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115802145",
            "telephone_number": "516-256-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "NICOLE",
        "middle_name": "PATRICIA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-22",
        "last_updated": "2022-08-22",
        "certification_date": "2022-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "NY",
            "license": "695945",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NY",
            "license": "432399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "WILLIAMS",
            "middle_name": "PATRICIA",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Valley Stream, NY

Sources for this page

Verify at the official NPI Registry.