Active NPI
Richard L Moore
- Supports Brokerage Agency
- Medina, OH
National Provider Identifier
1275104655
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Supports Brokerage Agency
- Practice address
- 5000 Gateway Dr
Suite 213
Medina, OH 44256 - Phone
- (330) 461-1164
- NPI assigned
- Jul 7, 2021
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Supports Brokerage Agency | 251X00000X | Primary |
Addresses
Primary practice location
5000 Gateway Dr
Suite 213
Medina, OH 44256
Mailing address
5000 Gateway Dr
Suite 213
Medina, OH 44256
Phone (330) 461-1164
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1625616000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626825600000",
"number": "1275104655",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5000 GATEWAY DR",
"address_2": "SUITE 213",
"city": "MEDINA",
"state": "OH",
"postal_code": "44256",
"telephone_number": "330-461-1164"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5000 GATEWAY DR",
"address_2": "SUITE 213",
"city": "MEDINA",
"state": "OH",
"postal_code": "44256",
"telephone_number": "330-461-1164"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "RICHARD",
"middle_name": "L",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-07-07",
"last_updated": "2021-07-21",
"certification_date": "2021-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "251X00000X",
"taxonomy_group": "",
"desc": "Supports Brokerage",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medina, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.