Marcus A Moore, DO

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

5101015942 Issued in MI

Practice address

6770 Dixie Hwy Ste 200
Clarkston, MI 48346-2089

Phone

(248) 625-2621

Fax

(248) 625-8938

NPI assigned

Jul 19, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mmoore3@direct.dmc.org

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.

• Medical Center Emergency Services

  • Emergency Medical Services (Emergency Medicine) Physician
  • Detroit, MI
  • NPI 1902855711
  Medicare reassignment NPD
• Obscare PC

  • Emergency Medicine Physician
  • Grand Blanc, MI
  • NPI 1255361598
  NPD (past)
• Stat Care PC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Flint, MI
  • NPI 1013919372
  NPD (past)
• Statcare PC

  • Emergency Medicine Physician
  • Grand Blanc, MI
  • NPI 1255333498
  NPD (past)

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083633887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5360 WILD DAISY CT",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483464984",
            "telephone_number": "248-921-9524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6770 DIXIE HWY STE 200",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483462089",
            "telephone_number": "248-625-2621",
            "fax_number": "248-625-8938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MARCUS",
        "middle_name": "A",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "5101015942",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN LICENSE",
            "identifier": "5101015942",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONTROLLED SUBSTANCE",
            "identifier": "5315024072",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephanie M Montrose, DO
• Ihsin Moo, NP
• Moonbeam Massage LLC
• Cheryl Moore, OT
• Kelly Moore, M.A., LLP
• Lorie Hertzler Moran
• Alyse M Morck, PA-C
• Rebekah Charis Morden, CNM
• Savannah Rose Morell
• Beverly Morey

• Emergency Medicine Physician in Clarkston, MI
• Providers in Clarkston, MI by specialty
• Emergency Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.