NPIMap

Individual provider Active NPI

Paul Douglas Moore, M.D.

  • Family Medicine Physician
  • Fountain Inn, SC
National Provider Identifier
1194769661
Registry record updated Sep 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
23342 Issued in SC
Practice address
910 N Main St Ste 100
Fountain Inn, SC 29644-1320
Phone
(864) 967-4982
NPI assigned
Jun 15, 2006
Last updated
Sep 18, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 23342 SC Primary

Addresses

Primary practice location

910 N Main St Ste 100
Fountain Inn, SC 29644-1320

Mailing address

1 Independence PT Ste 212
Greenville, SC 29615-4536
Phone (864) 797-6174

Other practice location 1

22725 Highway 76 E
Clinton, SC 29325-7527
Phone (864) 833-9100

Other practice location 2

701 Grove Rd Fl 1
Greenville, SC 29605-4210
Phone (864) 455-7899

Other identifiers 1

IdentifierTypeStateIssuer
4591406OtherSCAETNA ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20041019000536 SC Practitioner - Emergency Medicine 4082675574 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Medical University of South Carolina College of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Francis Physician Services IncGroup PAC ID 6608826821, 106 clinicians

Practice addresses (Care Compare)

1200 Brookfield Blvd
Suite 400B
Greenville, SC 29607-6583
Phone (864) 605-3721

910 N Main St
Fountain Inn, SC 29644-1320
Phone (864) 967-4982

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
29746TNMDNurse Practitioner
23342SCMDAdvanced Practice Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Greenville Health System CurrentSince Nov 30, 2013 Accepting new patients
Prisma Health-Upstate CurrentSince Oct 1, 2016 Accepting new patients
Greenville Health System Current Accepting new patients
Prisma Health-Upstate Current Accepting new patients
Greenville Health System CurrentSince Nov 30, 2013 Accepting new patients
Prisma Health-Upstate CurrentSince Oct 1, 2016 Accepting new patients
St Francis Physician Services Inc Family Medicine CurrentSince Sep 29, 2024 Accepting new patients
St Francis Physician Services Inc Family Medicine CurrentSince Sep 29, 2024 Accepting new patients
Lauderdale Radiology Group LLP PastSince Mar 30, 2025 Accepting new patients
St Francis Physician Services Inc Family Medicine Past Accepting new patients
Jellico Community Hospital Inc. Past Accepting new patients

Locations

22725 US Highway 76
Clinton, SC 29325
Phone (864) 833-9100

910 N Main St
Ste 100
Fountain Inn, SC 29644
Phone (864) 967-4982

1 Independence Pt
Ste 212
Greenville, SC 29615
Phone (864) 797-6306

1200 Brookfield Blvd
Ste 400B
Greenville, SC 29607
Phone (864) 605-3721

701 Grove Rd
Greenville, SC 29605
Phone (864) 454-2030

701 Grove Rd
Fl 1
Greenville, SC 29605
Phone (864) 455-7899

830 S Buncombe Rd
Greer, SC 29650
Phone (864) 797-8000

106 Parkview Dr
Laurens, SC 29360
Phone (864) 454-0888

298 Memorial Dr
Seneca, SC 29672
Phone (864) 482-3100

729 SE Main St
Simpsonville, SC 29681
Phone (864) 271-8647

807 N Main St
Travelers Rst, SC 29690
Phone (864) 834-5132

Interoperability endpoints

  • Direct secure messaging: pmoore2698499@direct.bsmhealth.org

Organizations & group practices 11

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": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726617600000",
    "number": "1194769661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 INDEPENDENCE PT STE 212",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154536",
            "telephone_number": "864-797-6174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 N MAIN ST STE 100",
            "city": "FOUNTAIN INN",
            "state": "SC",
            "postal_code": "296441320",
            "telephone_number": "864-967-4982"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22725 Highway 76 E",
            "address_purpose": "LOCATION",
            "city": "Clinton",
            "state": "SC",
            "postal_code": "293257527",
            "country_code": "US",
            "telephone_number": "864-833-9100",
            "fax_number": "864-933-9493",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "701 Grove Rd Fl 1",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296054210",
            "country_code": "US",
            "telephone_number": "864-455-7899",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "PAUL",
        "middle_name": "DOUGLAS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "23342",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA ID",
            "identifier": "4591406",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fountain Inn, SC

Sources for this page

Verify at the official NPI Registry.