Active NPI
Ellen Cecile Moore, MD
- Pediatrics Physician
- Greenbrier, AR
National Provider Identifier
1285681445
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- E-6324
- Practice address
- 14 Woodridge Dr
Greenbrier, AR 72058-9583 - Phone
- (248) 549-0861
- NPI assigned
- May 30, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 4301038528 | MI | |
| Pediatrics Physician | 208000000X | E-6324 | AR | Primary |
Addresses
Primary practice location
14 Woodridge Dr
Greenbrier, AR 72058-9583
Mailing address
14 Woodridge Dr
Greenbrier, AR 72058-9583
Phone (248) 549-0861
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E-6324 | AR | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1466467200000",
"number": "1285681445",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14 WOODRIDGE DR",
"city": "GREENBRIER",
"state": "AR",
"postal_code": "720589583",
"telephone_number": "248-549-0861"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14 WOODRIDGE DR",
"city": "GREENBRIER",
"state": "AR",
"postal_code": "720589583",
"telephone_number": "248-549-0861"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "ELLEN",
"middle_name": "CECILE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-30",
"last_updated": "2016-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MI",
"license": "4301038528",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "AR",
"license": "E-6324",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenbrier, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.