NPIMap

Individual provider Active NPI

Kevin Emmanual Moore, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • Warner Robins, GA
National Provider Identifier
1104111590
Registry record updated Feb 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
POD001181 Issued in GA
Practice address
109 Osigian Blvd Ste 300
Warner Robins, GA 31088-8924
Phone
(478) 333-2430
Fax
(478) 333-2173
NPI assigned
Jun 14, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 1, 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 288 OK
Foot & Ankle Surgery Podiatrist 213ES0103X POD001181 GA Primary

Addresses

Primary practice location

109 Osigian Blvd Ste 300
Warner Robins, GA 31088-8924

Mailing address

PO Box 6619
Macon, GA 31208-6619
Phone (478) 333-2430

Other practice location 1

4116 Arkwright Rd Ste 1
Macon, GA 31210-1707
Phone (478) 333-2430

Other identifiers 1

IdentifierTypeStateIssuer
003116370BMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120118000309 GA Practitioner - Podiatry 9931370608 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Barry University School of Podiatric Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1321 Interstate Pkwy
Augusta, GA 30909-5626
Phone (706) 945-0810

501 Osigian Blvd
Suite a
Warner Robins, GA 31088-9192
Phone (478) 333-2430

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue82
Removal of skin lesions112
Removal of nail tissue1338

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Moore Resolutions Group, LLC CurrentSince Jul 21, 2020 Accepting new patients
Aggeus Healthcare, P.C. Past Accepting new patients

Locations

4100 Riverside Dr
Ste 97
Macon, GA 31210
Phone (478) 216-5534

4116 Arkwright Rd
#1
Macon, GA 31210
Phone (478) 216-5534

109 Osigian Blvd
Ste 300
Warner Robins, GA 31088
Phone (478) 333-2430

Organizations & group practices 4

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.

Hospital & facility affiliations 5

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": "1308009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643673600000",
    "number": "1104111590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6619",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312086619",
            "telephone_number": "478-333-2430",
            "fax_number": "478-333-2173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 OSIGIAN BLVD STE 300",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310888924",
            "telephone_number": "478-333-2430",
            "fax_number": "478-333-2173"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4116 Arkwright Rd Ste 1",
            "address_purpose": "LOCATION",
            "city": "Macon",
            "state": "GA",
            "postal_code": "312101707",
            "country_code": "US",
            "telephone_number": "478-333-2430",
            "fax_number": "478-333-2173",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "KEVIN",
        "middle_name": "EMMANUAL",
        "credential": "D.P.M.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-14",
        "last_updated": "2022-02-01",
        "certification_date": "2022-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "OK",
            "license": "288",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "GA",
            "license": "POD001181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003116370B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Warner Robins, GA

Sources for this page

Verify at the official NPI Registry.