Individual provider Active NPI

James F Moore, CRNA

  • Certified Registered Nurse Anesthetist
  • Cookeville, TN
National Provider Identifier
1073503801
Registry record updated Jul 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
8966 Issued in TN
Practice address
100 W 4TH St
Suite 310
Cookeville, TN 38501-2448
Phone
(931) 528-7877
Fax
(931) 526-3261
NPI assigned
Oct 24, 2005
Last updated
Jul 13, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 8966 TN Primary

Addresses

Primary practice location

100 W 4TH St
Suite 310
Cookeville, TN 38501-2448

Mailing address

100 W 4TH St
Suite 310
Cookeville, TN 38501-2448
Phone (931) 528-7877

Other identifiers 4

IdentifierTypeStateIssuer
3602243MedicaidTN
3050226OtherTNBLUE CROSS BLUE SHIELD
430035974OtherTNMEDICARE RAILROAD
74320946MedicaidKY

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
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
8966TNMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278979200000",
    "number": "1073503801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 W 4TH ST",
            "address_2": "SUITE 310",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012448",
            "telephone_number": "931-528-7877",
            "fax_number": "931-526-3261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 W 4TH ST",
            "address_2": "SUITE 310",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012448",
            "telephone_number": "931-528-7877",
            "fax_number": "931-526-3261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "JAMES",
        "middle_name": "F",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-24",
        "last_updated": "2010-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "8966",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3602243",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "3050226",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "430035974",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "74320946",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cookeville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.