Joseph Kaleb Moore
Individual provider Active NPI Family Medicine Physician · Fortville, IN
NPI 1104354505 · NPPES record last updated Jul 6, 2021
Key facts
- NPI
- 1104354505
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 01086091A (IN)
- Practice address
- 545 Vitality Dr Ste 100a
Fortville, IN 46040-1373 - Phone
- (317) 621-9220
- Fax
- (317) 621-9222
- NPI assigned
- May 30, 2017
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Louisville School of Medicine, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Community Physicians of Indiana Inc
Practice addresses (Care Compare)
545 Vitality Dr
Suite 100a
Fortville, IN 46040-1373
Phone (317) 621-9220
Hospital & facility affiliations
- Community Hospital of Anderson and Madison County
- Community Hospital North
- Community Hospital East
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210712003475 | IN | Practitioner - Family Practice | 3678975745 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01086091A | IN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Physicians of Indiana Inc | Family Medicine | Current |
Accepting new patients |
| Community Physicians of Indiana Inc | Current |
Accepting new patients | |
| Community Health Network, Inc. | Past | Accepting new patients | |
| Major Hospital | Past | Accepting new patients |
Locations
5819 Reliable Pkwy
Chicago, IL 60686
545 Vitality Dr
#100A
Fortville, IN 46040
545 Vitality Dr
Ste 100A
Fortville, IN 46040
Phone (317) 621-9220
7120 Clearvista Dr
Ste 4000
Indianapolis, IN 46256
Phone (317) 621-7444
6626 E 75th St
Ste 500
Indianapolis, IN 46250
Phone (317) 621-7547
Interoperability endpoints
- jmoore456458@ecommunitydirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | KY | ||
| Family Medicine Physician | 207Q00000X | 01086091A | IN | Yes |
Addresses
Primary practice location
545 Vitality Dr Ste 100a
Fortville, IN 46040-1373
Mailing address
6626 E 75TH St Ste 500
Indianapolis, IN 46250-2890
Other practice location 1
500 S Preston St Rm 305
Louisville, KY 40202-1702
Phone (502) 852-8696
Other providers in Fortville, IN
- Aubrey Mayberry
- Charles J McCarter
- Lana Renee McDaniel
- Connie Metcalf
- Mica Metz
- Bradley R Morgan
- Mt. Vernon Community School Corporation
- Taha Mujahid
- Hari Shanthan Nagi Reddy
- Saranya Nagireddy
All providers in Fortville, IN · Family Medicine Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 6, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.