Individual provider Active NPI

Michael Sean Moore, M.D.

  • Internal Medicine Physician
  • Fort Leonard Wood, MO
National Provider Identifier
1184885378
Registry record updated Jul 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
53953 Issued in MN
Practice address
General Leonard Wood Army Community Hospital
4430 Missouri Avenue
Fort Leonard Wood, MO 65473-9098
Phone
(573) 596-0417
NPI assigned
Jun 19, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 25, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 53953 MN Primary

Addresses

Primary practice location

General Leonard Wood Army Community Hospital
4430 Missouri Avenue
Fort Leonard Wood, MO 65473-9098

Mailing address

8180 Belden Blvd
Cottage Grove, MN 55016-2645
Phone (651) 282-4283

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110706000352 MN Practitioner - Internal Medicine 5193903508 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
53953MNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Internal Medicine CurrentSince Jul 1, 2011 Accepting new patients
Fairview Health Services Current Accepting new patients
Fairview Health Services CurrentSince Jul 1, 2011 Accepting new patients

Locations

14101 Fairview Dr
Ste 300
Burnsville, MN 55337
Phone (612) 273-5400

6401 France Ave S
Minneapolis, MN 55435
Phone (952) 920-8477

400 Stinson Blvd
Fl 2
Minneapolis, MN 55413
Phone (612) 672-2203

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

Organizations & group practices 4

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753401600000",
    "number": "1184885378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8180 BELDEN BLVD",
            "city": "COTTAGE GROVE",
            "state": "MN",
            "postal_code": "550162645",
            "telephone_number": "651-282-4283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "GENERAL LEONARD WOOD ARMY COMMUNITY HOSPITAL",
            "address_2": "4430 MISSOURI AVENUE",
            "city": "FORT LEONARD WOOD",
            "state": "MO",
            "postal_code": "654739098",
            "telephone_number": "573-596-0417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MICHAEL",
        "middle_name": "SEAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-19",
        "last_updated": "2025-07-25",
        "certification_date": "2025-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "53953",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Leonard Wood, MO

Sources for this page

Verify at the official NPI Registry.