Patricia A Moore
Individual provider Active NPI Podiatrist · South Bend, IN
NPI 1144229246 · NPPES record last updated Dec 15, 2017
Key facts
- NPI
- 1144229246
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Podiatrist 213E00000X
- License
- 07000521A (IN)
- Practice address
- 52303 Emmons Rd
Ste A7
South Bend, IN 46637-4293 - Phone
- (574) 277-5390
- Fax
- (574) 277-6340
- NPI assigned
- Jul 20, 2005
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Podiatry
- Education
- Kent State University College of Podiatric Medicine, 1982
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Pokagon Band of Potawatomi Indians
Practice addresses (Care Compare)
324 E Dewey St
Buchanan, MI 49107-1494
Phone (574) 277-5390
32652 Kno
Dowagiac, MI 49047-9805
Phone (269) 782-4141
52303 Emmons Rd
Suite 30
South Bend, IN 46637-4288
52303 Emmons Rd
Suite A7
South Bend, IN 46637-4293
Phone (574) 277-5390
Merit-based Incentive Payment System (MIPS)
- Final score
- 67.89 of 100
- Quality
- 100
- Promoting interoperability
- 0
- Improvement activities
- 40
- Cost
- 76.31
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 12 |
| Removal of skin lesions | 1-10 |
| Removal of nail tissue | 1293 |
| Removal or shaving of skin growth | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in IN, MI, TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100907000806 | IN | Practitioner - Podiatry | 6002930419 | Practice locations: South Bend, IN |
| I20101110000152 | MI | Practitioner - Podiatry | 6002930419 | Practice locations: Buchanan, MI |
| I20120914000456 | TX | Practitioner - Podiatry | 6002930419 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 07000521A | IN | MD | Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pokagon Band of Potawatomi Indians | Current |
Accepting new patients |
Locations
57392 M 51 S
Dowagiac, MI 49047
Phone (269) 462-9587
32652 Kno
Dowagiac, MI 49047
Phone (269) 782-4141
Interoperability endpoints
- pmoore1270946@epic00.shdirect.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 5901001129 | MI | |
| Podiatrist | 213E00000X | 07000521A | IN | Yes |
Addresses
Primary practice location
52303 Emmons Rd
Ste A7
South Bend, IN 46637-4293
Mailing address
52303 Emmons Rd
Ste A7
South Bend, IN 46637-4293
Phone (574) 277-5390
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100223850A | Medicaid | IN | |
| 1470280 | Medicaid | MI |
Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 15, 2017. 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.