NPIMap

Individual provider Active NPI

Paul Dean Moore Jr., MD

  • Pediatrics Physician
  • Overland Park, KS
National Provider Identifier
1174575930
Registry record updated Jun 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
0430003 Issued in KS
Practice address
7840 W 165TH St Ste 210
Overland Park, KS 66223
Phone
(913) 373-2230
Fax
(913) 373-0999
NPI assigned
May 17, 2006
Last updated
Jun 27, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0430003 KS
Pediatrics Physician 208000000X 0430003 KS Primary

Addresses

Primary practice location

7840 W 165TH St Ste 210
Overland Park, KS 66223

Mailing address

7840 W 165TH St Ste 210
Overland Park, KS 66223-2993
Phone (913) 373-2230

Other identifiers 1

IdentifierTypeStateIssuer
100457270AMedicaidKS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100513000905 KS Practitioner - Internal MedicinePractitioner - Pediatric Medicine 2668500554 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
University of Missouri, Kansas City, School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

7820 W 165TH St
Ahmg OB Hospitalists at South Overland Park
Overland Park, KS 66223-2925
Phone (913) 373-2000

9100 W 74TH St
Merriam, KS 66204-4004

9301 W 74TH St
100 Ahmg Hematology Oncology at Shawnee
Merriam, KS 66204-2217
Phone (913) 632-9100

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Shawnee Mission Medical Center Inc Internal Medicine CurrentSince Aug 30, 2015 Accepting new patients

Locations

7840 W 165th St
Ste 210
Overland Park, KS 66223
Phone (913) 373-2230

9301 W 74th St
Ste 100
Shawnee Mission, KS 66204
Phone (913) 632-9100

9100 W 74th St
Shawnee Msn, KS 66204
Phone (913) 632-2230

Interoperability endpoints

  • Direct secure messaging: pmoore661346@adventhealth.direct-ci.com

Organizations & group practices 1

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 8

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": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530057600000",
    "number": "1174575930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7840 W 165TH ST STE 210",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662232993",
            "telephone_number": "913-373-2230",
            "fax_number": "913-373-0999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7840 W 165TH ST STE 210",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "66223",
            "telephone_number": "913-373-2230",
            "fax_number": "913-373-0999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "PAUL",
        "middle_name": "DEAN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2018-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KS",
            "license": "0430003",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KS",
            "license": "0430003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100457270A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Overland Park, KS

Sources for this page

Verify at the official NPI Registry.