NPIMap

Individual provider Active NPI

Kenneth Moore

  • Emergency Medicine Physician
  • Rocky Mount, NC
National Provider Identifier
1215030465
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
9800098 Issued in NC
Practice address
2460 Curtis Ellis Dr
Rocky Mount, NC 27804-2237
Phone
(252) 443-8172
NPI assigned
Sep 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 9800098 NC Primary

Addresses

Primary practice location

2460 Curtis Ellis Dr
Rocky Mount, NC 27804-2237

Mailing address

PO Box 409540
Atlanta, GA 30384-9540

Other identifiers 1

IdentifierTypeStateIssuer
89135T6MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20040510001636 NC Practitioner - Emergency Medicine 1052300407 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Washington University School of Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wake Emergency Physicians PAGroup PAC ID 9931002078, 269 clinicians

Practice addresses (Care Compare)

2460 Curtis Ellis Dr
Rocky Mount, NC 27804-2237
Phone (252) 962-8000

3000 New Bern Ave
Raleigh, NC 27610-1231
Phone (919) 350-8000

Hospital & facility affiliations

  • Unc Health Nash Hospital, Rocky Mount, NC, CCN 340147

Merit-based Incentive Payment System (MIPS)

Final score
96.95 of 100Reported as apm
Quality
82.44
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
82.58 of 100Reported as group
Quality
75.66
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Emergency Physicians PA Emergency Medicine CurrentSince Oct 1, 2019 Accepting new patients
Vidant Medical Group LLC CurrentSince Jun 8, 2021 Accepting new patients
Wake Emergency Physicians PA Emergency Medicine Current Accepting new patients
Wake Emergency Physicians PA Emergency Medicine CurrentSince Oct 1, 2019 Accepting new patients
Bestpractices of Pennsylvania PC Emergency Medicine Past Accepting new patients
Emergency Coverage Services, PC Past Accepting new patients
North Carolina Emergency Physicians, PLLC Emergency Medicine PastSince Feb 9, 2020 Accepting new patients

Locations

401 N Main St
Kenansville, NC 28349
Phone (910) 296-0941

3000 New Bern Ave
Raleigh, NC 27610
Phone (919) 350-7000

250 Smith Church Rd
Roanoke Rapids, NC 27870
Phone (252) 308-9699

2460 Curtis Ellis Dr
Rocky Mount, NC 27804
Phone (252) 443-8199

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

Organizations & group practices 9

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.

Hospital & facility affiliations 1

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": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1215030465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 409540",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303849540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2460 CURTIS ELLIS DR",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "278042237",
            "telephone_number": "252-443-8172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "KENNETH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-06",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "9800098",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89135T6",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rocky Mount, NC

Sources for this page

Verify at the official NPI Registry.