Active NPI
Bridget Moore
- Pediatrics Physician
- Grand Rapids, MI
National Provider Identifier
1104405414
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 4351047958
- Practice address
- 330 Barclay Ave NE Ste 300
Grand Rapids, MI 49503-2527 - Phone
- (616) 391-8810
- NPI assigned
- Apr 5, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatrics Physician | 208000000X | 4351047958 | MI | Primary |
Addresses
Primary practice location
330 Barclay Ave NE Ste 300
Grand Rapids, MI 49503-2527
Mailing address
330 Barclay Ave NE Ste 300
Grand Rapids, MI 49503-2527
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1617580800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653436800000",
"number": "1104405414",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "330 BARCLAY AVE NE STE 300",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495032527"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "330 BARCLAY AVE NE STE 300",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495032527",
"telephone_number": "616-391-8810"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "BRIDGET",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-05",
"last_updated": "2022-05-25",
"certification_date": "2022-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MI",
"license": "4351047958",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.