Jill M Moore, FNP-BC
Individual provider Active NPI Family Nurse Practitioner · Vassar, MI
NPI 1104811215 · NPPES record last updated Apr 6, 2021
Key facts
- NPI
- 1104811215
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 4704173083 (MI)
- Practice address
- 1212 W Saginaw Rd
Vassar, MI 48768-9483 - Phone
- (989) 823-5020
- Fax
- (989) 823-7881
- NPI assigned
- Sep 14, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 13
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mymichigan Medical Center Saginaw
Rau Physical Therapy Inc
Practice addresses (Care Compare)
1212 W Saginaw Rd
Vassar, MI 48768-9483
Phone (989) 823-5020
193 E Jefferson St
Frankenmuth, MI 48734-1935
Hospital & facility affiliations
- Mymichigan Medical Center Saginaw
- Covenant Medical Center
- McLaren Caro Region
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050315000389 | MI | Practitioner - Nurse Practitioner | 4486609203 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science, Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mymichigan Medical Center Saginaw | Current |
Accepting new patients | |
| Mymichigan Medical Center Saginaw | Family | Current |
Accepting new patients |
| Mymichigan Medical Center Saginaw | Current | Accepting new patients | |
| Mymichigan Medical Center Saginaw | Past | Accepting new patients | |
| Mymichigan Medical Center Saginaw | Past | Accepting new patients | |
| Mymichigan Medical Center Saginaw | Past | Accepting new patients |
Locations
4000 Wellness Dr
Midland, MI 48670
Phone (844) 832-1956
1212 W Saginaw Rd
Vassar, MI 48768
Phone (989) 823-5020
Interoperability endpoints
- jill.moore.1@11016.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 4704173083 | MI | Yes |
Addresses
Primary practice location
1212 W Saginaw Rd
Vassar, MI 48768-9483
Mailing address
PO Box 779
Tawas City, MI 48764-0779
Phone (855) 298-9888
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| M10200335 | Other | MI | TRICARE |
| 150533 | Other | MI | MEDICAID-GREATLAKES |
| 0877585 | Other | MI | BCBSMI |
| 4708328 | Medicaid | MI |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jillmoore@smomsjhs.allscriptsdirect.net |
Other providers in Vassar, MI
- Kayla Lapan
- Benjamin Leal
- Rebecca Marlene Lutz
- Carolyn Jean Mangel
- McLaren Caro Region
- Mymichigan Medical Center Saginaw
- Mymichigan Medical Center Saginaw
- Mymichigan Medical Center Saginaw
- Mark Nowaczewski
- Tina Marie Ohmer
All providers in Vassar, MI · Family Nurse Practitioner in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 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.