Active NPI
Nicholas Simon Alexander Moore, MD
- Pulmonary Disease Physician
- Salt Lake City, UT
National Provider Identifier
1255066031
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pulmonary Disease Physician
- License
- MED-PHYS-LIC-166632
- 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, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220831002297 | MT | Order and Referring Only - Internal 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
| License | State | Type | Specialty |
|---|---|---|---|
| 14209922-1205 | UT | MD | Sleep Medicine (Internal Medicine) Physician |
| MED-RES-LIC-113361 | MT | MD | Student 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.
-
dba Intermountain Health Riverton Hospital
- General Acute Care Hospital
- Riverton, UT
- NPI 1154551919
-
dba Intermountain Health Intermountain Medical Center
- General Acute Care Hospital
- Murray, UT
- NPI 1043220650
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 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.