Individual provider Active NPI

Ryan Allen Moore, M.D.

  • Pediatric Cardiology Physician
  • Cincinnati, OH
National Provider Identifier
1104090273
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
35.097581 Issued in OH
Practice address
3333 Burnet Ave
Cincinnati, OH 45229-3026
Phone
(513) 636-4432
Fax
(513) 636-3952
NPI assigned
Apr 18, 2008
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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Cardiology Physician 2080P0202X 49071 KY
Pediatric Cardiology Physician 2080P0202X 01076061A IN
Pediatric Cardiology Physician 2080P0202X 26744 WV
Pediatric Cardiology Physician 2080P0202X 35.097581 OH Primary

Addresses

Primary practice location

3333 Burnet Ave
Cincinnati, OH 45229-3026

Mailing address

3333 Burnet Ave
ML 2003
Cincinnati, OH 45229
Phone (513) 636-4432

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, KY2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20150609002982 OH Practitioner - Cardiovascular Disease (Cardiology) 6800117300 Reassigns benefits to 1 organization
I20171213003213 KY Practitioner - Pediatric Medicine 6800117300 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Indiana University School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3333 Burnet Ave
Cincinnati, OH 45229-3026
Phone (513) 636-4200

3333 Burnet Ave
Cincinnati, OH 45229-3039

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01076061AINMDPediatric Cardiology Physician
26744WVMDPediatric Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Kentucky CurrentSince Nov 15, 2017 Accepting new patients

Locations

800 Rose St
Lexington, KY 40536
Phone (859) 257-8562

770 Rose St
Lexington, KY 40536
Phone (859) 323-3368

3333 Burnet Ave
Cincinnati, OH 45229
Phone (513) 636-4200

3333 Burnet Ave
#5021
Cincinnati, OH 45229
Phone (513) 636-4225

3333 Burnet Ave
#2003
Cincinnati, OH 45229
Phone (513) 636-4432

Organizations & group practices 2

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": "1208476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1104090273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 BURNET AVE",
            "address_2": "ML 2003",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "45229",
            "telephone_number": "513-636-4432",
            "fax_number": "513-636-3952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 BURNET AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452293026",
            "telephone_number": "513-636-4432",
            "fax_number": "513-636-3952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "RYAN",
        "middle_name": "ALLEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-18",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "KY",
            "license": "49071",
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "IN",
            "license": "01076061A",
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "WV",
            "license": "26744",
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "OH",
            "license": "35.097581",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

Verify at the official NPI Registry.