Addison Moore

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

DO.3765 Issued in AL

Practice address

4310 Watermelon Rd
Northport, AL 35473-5166

Phone

(205) 330-5266

Fax

(205) 330-9915

NPI assigned

Mar 28, 2022

Last updated

Jul 9, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

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

Specialty

Family Practice

Education

Edward Via Col of Osteo Medicine-Virginia Campus, 2022

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• SLCM LLC

  dba NorthRiver Primary Care Associates

  • Family Medicine Physician
  • Northport, AL
  • NPI 1336474964
  NPD

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

{
    "created_epoch": "1648425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783555200000",
    "number": "1205586583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4310 WATERMELON RD",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "354735166",
            "telephone_number": "205-710-6129",
            "fax_number": "205-710-2116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4310 WATERMELON RD",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "354735166",
            "telephone_number": "205-330-5266",
            "fax_number": "205-330-9915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "ADDISON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-28",
        "last_updated": "2026-07-09",
        "certification_date": "2026-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "AL",
            "license": "DO.3765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• MKW Enterprise Inc.
• MMC, M.D., LLC
• Lyndsie Rhoden Montgomery, CRNP
• Shannon L Montgomery, CRNA
• Moore Family Health
• Janae Leigh Moore, MASSAGE THERAPIST
• John Michael Mullenix, LPC
• Joanne C Myers, M.D.
• Olivia P Nagus
• Richard Navickas II

• Sports Medicine (Family Medicine) Physician in Northport, AL
• Providers in Northport, AL by specialty
• Sports Medicine (Family Medicine) Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.