NPIMap

Individual provider Active NPI

Milan Shannon Moore, MD

  • Orthopaedic Surgery Physician
  • Olympia, WA
National Provider Identifier
1063490290
Registry record updated Jan 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
MD00039784 Issued in WA
Practice address
3901 Capital Mall Dr SW Ste a
Olympia, WA 98502-8654
Phone
(360) 786-8990
Fax
(360) 786-9010
NPI assigned
Jan 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X MD00039784 WA Primary

Addresses

Primary practice location

3901 Capital Mall Dr SW Ste a
Olympia, WA 98502-8654

Mailing address

PO Box 368
Olympia, WA 98507-0368
Phone (360) 491-8439

Other identifiers 5

IdentifierTypeStateIssuer
1001556MedicaidWA
GAB21356OtherWAMEDICARE LEGACY
8275349OtherWADSHS
148355OtherWALABOR & INDUSTRIES
5918MOOtherWAREGENCE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051019000667 WA Practitioner - Orthopedic Surgery 7810913829 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Harvard Medical School, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Olympia Orthopaedic Associates PLLCGroup PAC ID 2365337508, 87 clinicians

Practice addresses (Care Compare)

615 Lilly Rd NE
Olympia, WA 98506-5117
Phone (360) 491-4211

Hospital & facility affiliations

  • Providence at Home With Compassus, Puget Sound South Home health agency, Lacey, WA, CCN 507004
  • Providence St Peter Hospital Hospital, Olympia, WA, CCN 500024
  • Mason General Hospital & Family of Clinics Hospital, Shelton, WA, CCN 501336
  • Grays Harbor Community Hospital Hospital, Aberdeen, WA, CCN 500031
  • Summit Pacific Medical Center Hospital, Elma, WA, CCN 501304
  • Capital Medical Center Hospital, Olympia, WA, CCN 500139

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement54
Knee replacement54
Lower limb (leg) arthroscopy (minimally invasive joint repair)18
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD00039784WAMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Olympia Orthopaedic Associates PLLC CurrentSince Apr 1, 2017 Accepting new patients
Moore Medical Consulting, PS Current Accepting new patients
Public Hospital District No 1 of Mason County CurrentSince Jun 19, 2024 Accepting new patients
Public Hospital District No 1 of Mason County Wa CurrentSince Jun 19, 2024 Accepting new patients
Olympia Orthopaedic Associates, PLLC CurrentSince Apr 1, 2017 Accepting new patients
Public Hospital District No 1 of Mason County CurrentSince Jun 19, 2024 Accepting new patients
Providence Health & Services Washington Past Accepting new patients

Locations

615 Lilly Rd NE
Ste 100
Olympia, WA 98506
Phone (360) 491-4211

3901 Capital Mall Dr SW
Ste B
Olympia, WA 98502
Phone (360) 528-8571

3901 Capital Mall Dr SW
#A
Olympia, WA 98502
Phone (360) 570-3460

3901 Capital Mall Dr SW
Olympia, WA 98502
Phone (360) 709-6221

615 Lilly Rd NE
Ste 240
Olympia, WA 98506
Phone (360) 413-3850

901 Mountain View Dr
Shelton, WA 98584
Phone (360) 426-1611

Interoperability endpoints

  • Direct secure messaging: milan.moore.1@5512.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/5512/brand/1/csg/1/fhir/r4

Organizations & group practices 7

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 11

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": "1136505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705708800000",
    "number": "1063490290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 368",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985070368",
            "telephone_number": "360-491-8439",
            "fax_number": "360-491-6328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 CAPITAL MALL DR SW STE A",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985028654",
            "telephone_number": "360-786-8990",
            "fax_number": "360-786-9010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MILAN",
        "middle_name": "SHANNON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-06",
        "last_updated": "2024-01-20",
        "certification_date": "2024-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "WA",
            "license": "MD00039784",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1001556",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE LEGACY",
            "identifier": "GAB21356",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DSHS",
            "identifier": "8275349",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "148355",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "5918MO",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia, WA

Sources for this page

Verify at the official NPI Registry.