Individual provider Active NPI

Kyle R Moore, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • Crosby, MN
National Provider Identifier
1093155442
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
1051 Issued in MN
Practice address
320 East Main Street
Crosby, MN 56441
Phone
(218) 546-7000
Fax
(218) 546-4400
NPI assigned
Jun 30, 2013
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X PO3825 FL
Foot & Ankle Surgery Podiatrist 213ES0103X 1051 MN Primary

Addresses

Primary practice location

320 East Main Street
Crosby, MN 56441

Mailing address

320 East Main Street
Crosby, MN 56441
Phone (218) 546-7000

Other practice location 1

901 45th Street
Kimmel Bldg
West Palm Beach, FL 33407-2413
Phone (561) 844-5255

Other identifiers 1

IdentifierTypeStateIssuer
BJ7BUOtherFLFLORIDA BLUE

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kmoore488951@excellian.direct.allina.com Direct Cuyuna Regional Medical Center
Direct Messaging Address kmoore488951@excellian.direct.allina.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, MN2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20161205000317 FL Practitioner - Podiatry 6406136761 Reassigns benefits to 1 organization
I20200520001417 MN Practitioner - Podiatry 6406136761 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cuyuna Regional Medical CenterGroup PAC ID 9537146550, shared by 3 NPIs, 133 clinicians

Practice addresses (Care Compare)

320 E Main St
Crosby, MN 56441-1645
Phone (218) 546-7000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.78 of 100Reported as apm
Quality
80.38
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1051MNMDMarriage & Family Therapist
PO3825FLMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Ankle & Foot Center of Tampa Bay Foot & Ankle Surgery CurrentSince Aug 1, 2017 Accepting new patients
Ankle & Foot Center of Tampa Bay Foot & Ankle Surgery CurrentSince Aug 1, 2017 Accepting new patients
Cuyuna Regional Medical Center CurrentSince Jun 1, 2020 Accepting new patients
Cuyuna Regional Medical Center CurrentSince Jun 1, 2020 Accepting new patients
Cuyuna Regional Medical Center Current Accepting new patients

Locations

13907 N Dale Mabry Hwy
Tampa, FL 33618
Phone (813) 963-1833

2835 W De Leon St
Ste 101
Tampa, FL 33609
Phone (813) 254-4747

2039 Little Rd
#A
Trinity, FL 34655
Phone (727) 845-0880

13205 Isle Dr
Baxter, MN 56425
Phone (218) 454-7600

320 E Main St
Crosby, MN 56441
Phone (218) 546-7000

Interoperability endpoints

  • Direct secure messaging: kmoore488951@excellian.direct.allina.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1372550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1093155442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 EAST MAIN STREET",
            "city": "CROSBY",
            "state": "MN",
            "postal_code": "56441",
            "telephone_number": "218-546-7000",
            "fax_number": "218-546-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 EAST MAIN STREET",
            "city": "CROSBY",
            "state": "MN",
            "postal_code": "56441",
            "telephone_number": "218-546-7000",
            "fax_number": "218-546-4400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "901 45th Street",
            "address_2": "Kimmel Bldg",
            "address_purpose": "LOCATION",
            "city": "West Palm Beach",
            "state": "FL",
            "postal_code": "334072413",
            "country_code": "US",
            "telephone_number": "561-844-5255",
            "fax_number": "561-844-5245",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "KYLE",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-30",
        "last_updated": "2022-07-21",
        "certification_date": "2020-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "FL",
            "license": "PO3825",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MN",
            "license": "1051",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BLUE",
            "identifier": "BJ7BU",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kmoore488951@excellian.direct.allina.com",
            "affiliation": "Y",
            "affiliationName": "Cuyuna Regional Medical Center",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "kmoore488951@excellian.direct.allina.com",
            "address_1": "320 E Main St",
            "city": "Crosby",
            "state": "MN",
            "country_code": "US",
            "postal_code": "564411645",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kmoore488951@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "PDA/PDF/TXT",
            "address_1": "320 E Main St",
            "city": "Crosby",
            "state": "MN",
            "country_code": "US",
            "postal_code": "564411645",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Crosby, MN

Sources for this page

Verify at the official NPI Registry.