Mary D Moore, M.D.

Primary specialty

Pediatric Rheumatology PhysicianTaxonomy code 2080P0216X

License

4301080845 Issued in MI

Practice address

1000 Houghton Ave
Saginaw, MI 48602-5303

Phone

(989) 746-7500

Fax

(989) 746-7752

NPI assigned

Mar 17, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mmoore45484@direct.covenanthealthcare.com

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.

• Saginaw Cooperative Hospitals, Inc

  • Internal Medicine Physician
  • Saginaw, MI
  • NPI 1346344991
  Medicare reassignment NPD
• Western Michigan University School of Medicine

  • Multi-Specialty Clinic/Center
  • Kalamazoo, MI
  • NPI 1316212343
  Medicare reassignment NPD
• Saginaw Cooperative Hospital Inc

  • Hospitalist Physician
  • Saginaw, MI
  • NPI 1548877434
  NPD
• Saginaw Cooperative Hospitals, Inc

  • Pediatrics Physician
  • Saginaw, MI
  • NPI 1821378688
  NPD
• Covenant Medical Center, Inc.

  • General Acute Care Hospital
  • Saginaw, MI
  • NPI 1588656946
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617062400000",
    "number": "1275502445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 HOUGHTON AVE",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486025303",
            "telephone_number": "989-746-7500",
            "fax_number": "989-746-7752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 HOUGHTON AVE",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486025303",
            "telephone_number": "989-746-7500",
            "fax_number": "989-746-7752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MARY",
        "middle_name": "D",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-17",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0216X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Rheumatology",
            "state": "MI",
            "license": "4301080845",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "3503906282",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4440356",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmoore45484@direct.covenanthealthcare.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1000 Houghton Ave",
            "city": "Saginaw",
            "state": "MI",
            "country_code": "US",
            "postal_code": "486025303",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kelita Leshea Moore, NURSE
• Kirstin Marie Moore
• Kristen Michelle Moore, PT, DPT
• Kristine L Moore
• Leatta Moore, LLMSW
• Olivia Paris Moore
• Lourdes Morales-Dopico, MD
• Mark Morden
• Kaylinn Morell
• Megan Lynn Morell, LMSW

• Pediatric Rheumatology Physician in Saginaw, MI
• Providers in Saginaw, MI by specialty
• Pediatric Rheumatology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.