Individual provider Active NPI

Elea Moore

  • Physician Assistant
  • Birmingham, AL
National Provider Identifier
1205679420
Registry record updated Jun 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1716 9TH Ave S
Birmingham, AL 35233-1124
Phone
(205) 934-5149
NPI assigned
Jun 15, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

1716 9TH Ave S
Birmingham, AL 35233-1124

Mailing address

1716 9TH Ave S
Birmingham, AL 35233-1124

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250905001317 AL Practitioner - Physician Assistant 3274035605 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1643 NW 136TH Ave
Sunrise, FL 33323-3091

409 Woodland VLG
Birmingham, AL 35216-1112

4535 Dressier Rd NW
Canton, OH 44718-2545

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

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.

NPI Registry JSON

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

{
    "created_epoch": "1718409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718409600000",
    "number": "1205679420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1716 9TH AVE S",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352331124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1716 9TH AVE S",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352331124",
            "telephone_number": "205-934-5149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "ELEA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-15",
        "last_updated": "2024-06-15",
        "certification_date": "2024-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Birmingham, AL

Sources for this page

Verify at the official NPI Registry.