Active NPI
Shenell Moore, RMA
- Medical Technologist
- Hammond, IN
National Provider Identifier
1215545363
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Technologist
- License
- 2811784
- Practice address
- 225 Gostlin St
Hammond, IN 46327-1302 - Phone
- (708) 953-2575
- Fax
- (219) 289-9108
- NPI assigned
- Jul 15, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Technologist | 246QM0706X | 2811784 | IL | Primary |
Addresses
Primary practice location
225 Gostlin St
Hammond, IN 46327-1302
Mailing address
225 Gostlin St
Hammond, IN 46327-1302
Phone (708) 953-2575
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 202006291401707 | Other | IN | HOME HEALTH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Medical Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2811784 | IL | MD | Medical Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594771200000",
"number": "1215545363",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "225 GOSTLIN ST",
"city": "HAMMOND",
"state": "IN",
"postal_code": "463271302",
"telephone_number": "708-953-2575",
"fax_number": "219-289-9108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "225 GOSTLIN ST",
"city": "HAMMOND",
"state": "IN",
"postal_code": "463271302",
"telephone_number": "708-953-2575",
"fax_number": "219-289-9108"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "SHENELL",
"credential": "RMA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-07-15",
"last_updated": "2020-07-15",
"certification_date": "2020-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "246QM0706X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Pathology, Medical Technologist",
"state": "IL",
"license": "2811784",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HOME HEALTH",
"identifier": "202006291401707",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hammond, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.