Individual provider Active NPI

Rebecca Moore, APRN, DNP

  • Nurse Practitioner
  • Edgewood, KY
National Provider Identifier
1174132070
Registry record updated Mar 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
3015990 Issued in KY
Practice address
1 Medical Village Dr
Edgewood, KY 41017-3403
Phone
(859) 301-0124
Fax
(859) 344-5552
NPI assigned
Jul 27, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 3015990 KY Primary
Acute Care Nurse Practitioner 363LA2100X LE-00033347 OH

Addresses

Primary practice location

1 Medical Village Dr
Edgewood, KY 41017-3403

Mailing address

PO Box 636324
Cincinnati, OH 45263-6324
Phone (859) 301-0124

Other practice location 1

2139 Auburn Ave
Cincinnati, OH 45219-2906
Phone (513) 585-2311

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210608003492 KY Practitioner - Nurse Practitioner 1951721992 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Elizabeth Medical Center, IncGroup PAC ID 0648174623, 187 clinicians

Practice addresses (Care Compare)

1 Medical Village Dr
Edgewood, KY 41017-3403
Phone (859) 301-2237

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.01 of 100Reported as apm
Quality
86.02
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
LE-00033347OHMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Elizabeth Medical Center, Inc CurrentSince May 3, 2021 Accepting new patients
St Elizabeth Medical Center, Inc Nurse Practitioner CurrentSince May 3, 2021 Accepting new patients

Locations

1500 James Simpson Jr Way
Covington, KY 41011
Phone (859) 655-4353

1 Medical Village Dr
Edgewood, KY 41017
Phone (859) 301-2000

711 Medical Village Dr
Edgewood, KY 41017
Phone (859) 287-3045

238 Barnes Rd
Williamstown, KY 41097
Phone (859) 292-4000

Interoperability endpoints

  • Direct secure messaging: rmoore348380@direct-prd.stelizabeth.com

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1595808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741651200000",
    "number": "1174132070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 636324",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452636324",
            "telephone_number": "859-301-0124",
            "fax_number": "859-301-0699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL VILLAGE DR",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410173403",
            "telephone_number": "859-301-0124",
            "fax_number": "859-344-5552"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2139 Auburn Ave",
            "address_purpose": "LOCATION",
            "city": "Cincinnati",
            "state": "OH",
            "postal_code": "452192906",
            "country_code": "US",
            "telephone_number": "513-585-2311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "REBECCA",
        "credential": "APRN, DNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-27",
        "last_updated": "2025-03-11",
        "certification_date": "2025-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "3015990",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "OH",
            "license": "LE-00033347",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edgewood, KY

Sources for this page

Verify at the official NPI Registry.