Individual provider Active NPI

Nicholas Simon Alexander Moore, MD

  • Pulmonary Disease Physician
  • Salt Lake City, UT
National Provider Identifier
1255066031
Registry record updated Jul 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
MED-PHYS-LIC-166632 Issued in MT
Practice address
30 N Mario Capecchi Dr RM 3N100
Salt Lake City, UT 84112
Phone
(801) 581-2121
NPI assigned
Jul 18, 2022
Last updated
Jul 2, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X MED-RES-LIC-113361 MT
Pulmonary Disease Physician 207RP1001X MED-PHYS-LIC-166632 MT Primary
Sleep Medicine (Internal Medicine) Physician 207RS0012X 14209922-1205 UT

Addresses

Primary practice location

30 N Mario Capecchi Dr RM 3N100
Salt Lake City, UT 84112

Mailing address

30 N Mario Capecchi Dr RM 3N100
Salt Lake City, UT 84112
Phone (801) 581-2121

Other practice location 1

801 N 29th St
Billings, MT 59101-0905
Phone (406) 238-2500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT
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

Enrollment IDStateProvider typePAC IDDetails
I20220831002297 MT Order and Referring Only - Internal MedicinePractitioner - Internal MedicinePractitioner - Sleep Medicine 2466836085

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary Disease
Education
Other, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

500 Eldorado Blvd
Suite 4300
Broomfield, CO 80021-3564

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
14209922-1205UTMDSleep Medicine (Internal Medicine) Physician
MED-RES-LIC-113361MTMDStudent in an Organized Health Care Education/Training Program

Hospital & facility affiliations 2

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": "1658102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782950400000",
    "number": "1255066031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 N MARIO CAPECCHI DR RM 3N100",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "84112",
            "telephone_number": "801-581-2121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 N MARIO CAPECCHI DR RM 3N100",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "84112",
            "telephone_number": "801-581-2121"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "801 N 29th St",
            "address_purpose": "LOCATION",
            "city": "Billings",
            "state": "MT",
            "postal_code": "591010905",
            "country_code": "US",
            "telephone_number": "406-238-2500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "NICHOLAS",
        "middle_name": "SIMON ALEXANDER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-18",
        "last_updated": "2026-07-02",
        "certification_date": "2026-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MT",
            "license": "MED-RES-LIC-113361",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MT",
            "license": "MED-PHYS-LIC-166632",
            "primary": true
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "UT",
            "license": "14209922-1205",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.