Individual provider Active NPI

Stephen Moore, MD

  • Diagnostic Radiology Physician
  • Denver, CO
National Provider Identifier
1104280478
Registry record updated Sep 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
65302 Issued in TN
Practice address
1721 E 19TH Ave Ste 520
Denver, CO 80218-1243
Phone
(303) 839-6741
NPI assigned
Apr 12, 2016
Last updated
Sep 29, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2026

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 0101289713 VA
Diagnostic Radiology Physician 2085R0202X 29924 MS
Student in an Organized Health Care Education/Training Program 390200000X
Nuclear Radiology Physician 2085N0904X 65302 TN
Diagnostic Radiology Physician 2085R0202X 65302 TN Primary

Addresses

Primary practice location

1721 E 19TH Ave Ste 520
Denver, CO 80218-1243

Mailing address

1721 E 19TH Ave Ste 520
Denver, CO 80218-1243

Other practice location 1

262 Danny Thomas Pl
Memphis, TN 38105-3678
Phone (901) 595-3300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, TN, GA3 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 3

Enrollment IDStateProvider typePAC IDDetails
I20220527000169 MS Practitioner - Diagnostic Radiology 1658759964 Reassigns benefits to 1 organization
I20220601000257 TN Practitioner - Diagnostic Radiology 1658759964 Reassigns benefits to 2 organizations
I20251001003653 GA Practitioner - Diagnostic RadiologyPractitioner - Nuclear Medicine 1658759964 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Columbia University College of Physicians and Surgeons, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memphis Radiological PCGroup PAC ID 1557333226, 50 clinicians
Summit Imaging Services LLCGroup PAC ID 9436597945, 71 clinicians
Summit Radiology Services P CGroup PAC ID 3577454024, 70 clinicians

Practice addresses (Care Compare)

1265 Union Ave
Memphis, TN 38104-3415
Phone (901) 516-7600

200 Industrail Blvd
Dublin, GA 31021-2981
Phone (478) 275-2000

4250 Bethel Rd
Olive Branch, MS 38654-8737
Phone (662) 932-9000

960 Joe Frank Harris Pkwy SE
Cartersville, GA 30120-2129
Phone (770) 382-1530

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.97 of 100Reported as group
Quality
92.01
Improvement activities
40
Cost
77.86

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101289713VAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Imaging Services LLC Diagnostic Radiology CurrentSince Sep 16, 2025 Accepting new patients
Tanner Imaging Center CurrentSince Sep 22, 2025 Accepting new patients
Summit Radiology Services P C Diagnostic Radiology CurrentSince Sep 16, 2025 Accepting new patients
St Jude Children's Research Hospital, Inc. CurrentSince Mar 20, 2023 Accepting new patients
Memphis Radiological, P.C. Diagnostic Radiology CurrentSince Jul 1, 2022 Accepting new patients
Memphis Radiological, P.C. Diagnostic Radiology CurrentSince Jul 1, 2022 Accepting new patients
Tanner Medical Group Inc PastSince Sep 22, 2025 Accepting new patients

Locations (25 of 34)

706 Dixie St
Ste 100
Carrollton, GA 30117
Phone (770) 812-8614

960 Joe Frank Harris Pkwy SE
Cartersville, GA 30120
Phone (404) 554-2196

104 Fairview Park Dr
Ste 100
Dublin, GA 31021
Phone (478) 272-3766

200 Industrial Blvd
Dublin, GA 31021
Phone (478) 274-3865

222 Perry Hwy
Hawkinsville, GA 31036
Phone (229) 200-4950

1266 Highway 515 S
Jasper, GA 30143
Phone (706) 301-5350

1133 Eagles Landing Pkwy
Stockbridge, GA 30281
Phone (678) 604-1000

551 Medical Dr
Clarksdale, MS 38614
Phone (662) 624-2531

705 N State St
Clarksdale, MS 38614
Phone (662) 621-2192

1938 Crescent Meadows Dr
Holly Springs, MS 38635
Phone (662) 252-1599

4250 Bethel Rd
Olive Branch, MS 38654
Phone (662) 932-9000

5480 Goodman Rd
Olive Branch, MS 38654
Phone (662) 893-9800

103 Halls Cv
Senatobia, MS 38668
Phone (662) 562-9003

3674 Goodman Rd E
#E
Southaven, MS 38672

7400 Airways Blvd
Southaven, MS 38671
Phone (662) 536-1000

1377 S Germantown Rd
Germantown, TN 38138
Phone (901) 516-6792

7800 Wolf Trail Cv
Germantown, TN 38138
Phone (901) 682-9222

1265 Union Ave
Memphis, TN 38104
Phone (901) 516-2362

1300 Wesley Dr
Memphis, TN 38116
Phone (901) 516-3700

1801 Union Ave
Memphis, TN 38104
Phone (901) 516-6792

1803 Union Ave
Ste 2
Memphis, TN 38104
Phone (901) 722-3136

225 S Claybrook St
Memphis, TN 38104
Phone (901) 516-2152

262 Danny Thomas Pl
Memphis, TN 38105
Phone (888) 226-4343

3950 New Covington Pike
Memphis, TN 38128
Phone (901) 516-5766

3960 New Covington Pike
Memphis, TN 38128
Phone (901) 516-5200

Interoperability endpoints

  • Direct secure messaging: smoore33205@mlh.direct-ci.com

Organizations & group practices 8

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 7

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": "1460419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790640000000",
    "number": "1104280478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1721 E 19TH AVE STE 520",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802181243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 E 19TH AVE STE 520",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802181243",
            "telephone_number": "303-839-6741"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "262 Danny Thomas Pl",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381053678",
            "country_code": "US",
            "telephone_number": "901-595-3300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "STEPHEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-12",
        "last_updated": "2026-09-29",
        "certification_date": "2026-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "VA",
            "license": "0101289713",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MS",
            "license": "29924",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "",
            "desc": "Radiology, Nuclear Radiology",
            "state": "TN",
            "license": "65302",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TN",
            "license": "65302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

Verify at the official NPI Registry.