NPIMap

Individual provider Active NPI

John Russell Moore, M.D.

  • Urology Physician
  • Independence, MO
National Provider Identifier
1114977550
Registry record updated Sep 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
2001004851 Issued in MO
Practice address
19001 E 48TH St S
Independence, MO 64055
Phone
(816) 836-8831
Fax
(816) 795-0144
NPI assigned
May 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 2001004851 MO Primary

Addresses

Primary practice location

19001 E 48TH St S
Independence, MO 64055

Mailing address

19001 E 48TH St S
Independence, MO 64055
Phone (816) 836-8831

Other identifiers 1

IdentifierTypeStateIssuer
204467005MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, KS2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100514000144 MO Practitioner - Urology 1456319144 Reassigns benefits to 1 organization
I20200416002760 KS Practitioner - Urology 1456319144 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Urologic Associates IncGroup PAC ID 7618133778, 14 clinicians

Practice addresses (Care Compare)

12300 Metcalf Ave
Overland Park, KS 66213-1324
Phone (816) 251-5100

12330 Metcalf Ave
Suite 500a
Overland Park, KS 66213-1313
Phone (816) 251-5100

19001 E 48TH St S
Independence, MO 64055-6964
Phone (816) 251-5100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.88 of 100Reported as group
Quality
85.13
Promoting interoperability
100
Improvement activities
40
Cost
71.13

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2001004851MOMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Urologic Associates, Inc Urology CurrentSince Jul 1, 2012 Accepting new patients
Midwest Urology & Radiation Oncology, Inc, PC. Urology Past Accepting new patients

Locations

12330 Metcalf Ave
Ste 500A
Overland Park, KS 66213
Phone (913) 323-9000

615 W Nursery St
Butler, MO 64730
Phone (660) 200-2004

19001 E 48th St S
Independence, MO 64055
Phone (816) 836-6875

17525 Medical Center Pkwy
Independence, MO 64057
Phone (816) 836-6875

901 E 104th St
#400S
Kansas City, MO 64131
Phone (816) 502-7117

Interoperability endpoints

  • Direct secure messaging: jmoore4982@direct.saint-lukes.org
  • Direct secure messaging: johnmoore@auai.allscriptsdirect.net

Organizations & group practices 2

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": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411257600000",
    "number": "1114977550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19001 E 48TH ST S",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "64055",
            "telephone_number": "816-836-8831",
            "fax_number": "816-795-0144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19001 E 48TH ST S",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "64055",
            "telephone_number": "816-836-8831",
            "fax_number": "816-795-0144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "JOHN",
        "middle_name": "RUSSELL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-10",
        "last_updated": "2014-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MO",
            "license": "2001004851",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "204467005",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Independence, MO

Sources for this page

Verify at the official NPI Registry.