Active NPI
Jefferson Wilburn Moore Jr., APN
- Adult Health Nurse Practitioner
- Batesville, AR
National Provider Identifier
1104128867
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- ATP-000312
- Practice address
- 1710 Harrison St
Batesville, AR 72501-7303 - Phone
- (870) 262-1338
- Fax
- (870) 262-1336
- NPI assigned
- Nov 30, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | ATP-000312 | AR | Primary |
Addresses
Primary practice location
1710 Harrison St
Batesville, AR 72501-7303
Mailing address
1710 Harrison St
Batesville, AR 72501-7303
Phone (870) 262-1338
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110314000870 | AR | Practitioner - Nurse Practitioner | 9133301005 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- White River Health System, Inc.
Practice addresses (Care Compare)
16 Hospital Cir
Suite a
Batesville, AR 72501-7343
Phone (870) 793-7519
Hospital & facility affiliations
- Adoration Home Health
- Elite Home Health
- White River Medical Center
- Stone County Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ATP-000312 | AR | MD | Adult Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| White River Health System, Inc. | Current | Accepting new patients |
Locations
1710 Harrison St
Batesville, AR 72501
Phone (870) 262-1240
16 Hospital Cir
Ste A
Batesville, AR 72501
Phone (870) 269-4361
1217 Batesville Blvd
Southside, AR 72501
Phone (870) 262-2800
Interoperability endpoints
- jefferson.moore.1@13831.direct.athenahealth.com
Organizations & group practices 1
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 19
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Batesville, AR
- NPI 1821040312
-
- Home Health Agency
- Salem, AR
- NPI 1295852366
-
- Orthopaedic Surgery Physician
- Batesville, AR
- NPI 1265821193
Hospital
-
- Pain Medicine (Anesthesiology) Physician
- Batesville, AR
- NPI 1558447599
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1291075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1291075200000",
"number": "1104128867",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1710 HARRISON ST",
"city": "BATESVILLE",
"state": "AR",
"postal_code": "725017303",
"telephone_number": "870-262-1338",
"fax_number": "870-262-1336"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1710 HARRISON ST",
"city": "BATESVILLE",
"state": "AR",
"postal_code": "725017303",
"telephone_number": "870-262-1338",
"fax_number": "870-262-1336"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "JEFFERSON",
"middle_name": "WILBURN",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "APN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-11-30",
"last_updated": "2010-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "AR",
"license": "ATP-000312",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Batesville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2010; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.