Individual provider Active NPI

Meagan Nicole Moore, CRNA

  • Certified Registered Nurse Anesthetist
  • Bowling Green, KY
National Provider Identifier
1104418078
Registry record updated Feb 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
3015758 Issued in KY
Practice address
250 Park St
Bowling Green, KY 42101-1760
Phone
(270) 745-1000
NPI assigned
Feb 10, 2021
Last updated
Feb 10, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 10, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 3015758 KY Primary

Addresses

Primary practice location

250 Park St
Bowling Green, KY 42101-1760

Mailing address

1015 Webb Rd
Clarksville, TN 37040-5409

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210319002021 KY Practitioner - Certified Registered Nurse Anesthetist (Crna) 0547677452 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jennie Stuart Medical Center IncGroup PAC ID 4183607252, 113 clinicians

Practice addresses (Care Compare)

320 W 18TH St
Hopkinsville, KY 42240-1965
Phone (270) 887-0100

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Commonwealth Health Corporation, Inc Nurse Anesthetist, Certified Registered CurrentSince Mar 1, 2021 Accepting new patients
Commonwealth Health Corporation, Inc. CurrentSince Mar 1, 2021 Accepting new patients
Jennie Stuart Medical Center Inc Nurse Anesthetist, Certified Registered Current Accepting new patients
Jennie Stuart Medical Center Inc Nurse Anesthetist, Certified Registered CurrentSince Aug 1, 2024 Accepting new patients
Commonwealth Health Corporation, Inc Current Accepting new patients
Jennie Stuart Medical Center Inc CurrentSince Aug 1, 2024 Accepting new patients

Locations

250 Park St
Bowling Green, KY 42101
Phone (270) 745-1000

350 Park St
Ste 203
Bowling Green, KY 42101
Phone (270) 781-0075

10755 Eagle Way
Ste 202
Hopkinsville, KY 42240
Phone (270) 887-5640

320 W 18th St
Hopkinsville, KY 42240
Phone (270) 887-0100

Organizations & group practices 6

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 1

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": "1612915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612915200000",
    "number": "1104418078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 WEBB RD",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370405409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 PARK ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421011760",
            "telephone_number": "270-745-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MEAGAN",
        "middle_name": "NICOLE",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-10",
        "last_updated": "2021-02-10",
        "certification_date": "2021-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "3015758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.