Individual provider Active NPI

Stephen R Moore, MD

  • Pulmonary Disease Physician
  • Middletown, OH
National Provider Identifier
1083681076
Registry record updated May 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
35054764 Issued in OH
Practice address
1040 Summitt SQ
Middletown, OH 45042-3400
Phone
(513) 425-0533
Fax
(513) 425-0527
NPI assigned
Mar 8, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 15, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X 35054764 OH Primary

Addresses

Primary practice location

1040 Summitt SQ
Middletown, OH 45042-3400

Mailing address

1040 Summitt SQ
Middletown, OH 45042-3400
Phone (513) 425-0533

Other identifiers 1

IdentifierTypeStateIssuer
0766827MedicaidOH

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
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35054764OHMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Neurological & Sleep Disorders Inc Pulmonary Disease PastSince Apr 30, 2023 Accepting new patients
Your MD, LLC PastSince Aug 1, 2003 Accepting new patients
Noble Allman DC Inc PastSince Mar 22, 2010 Accepting new patients

Organizations & group practices 3

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": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210809600000",
    "number": "1083681076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 SUMMITT SQ",
            "city": "MIDDLETOWN",
            "state": "OH",
            "postal_code": "450423400",
            "telephone_number": "513-425-0533",
            "fax_number": "513-425-0527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 SUMMITT SQ",
            "city": "MIDDLETOWN",
            "state": "OH",
            "postal_code": "450423400",
            "telephone_number": "513-425-0533",
            "fax_number": "513-425-0527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "STEPHEN",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-08",
        "last_updated": "2008-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "OH",
            "license": "35054764",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0766827",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Middletown, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2008; 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.