Active NPI
Charles Rodney Moore, PA
- Physician Assistant
- Ann Arbor, MI
National Provider Identifier
1285776534
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601001292
- Practice address
- 1500 East Medical Center Dr
2ND Floor Taubman Ctr Recp F
Ann Arbor, MI 48109-0332 - Phone
- (734) 936-5738
- NPI assigned
- Feb 13, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601001292 | MI | Primary |
Addresses
Primary practice location
1500 East Medical Center Dr
2ND Floor Taubman Ctr Recp F
Ann Arbor, MI 48109-0332
Mailing address
3621 S State St
700 KMS Place
Ann Arbor, MI 48108
Phone (734) 936-2047
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2656213 | Medicaid | MI |
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
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1285776534",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3621 S STATE ST",
"address_2": "700 KMS PLACE",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "48108",
"telephone_number": "734-936-2047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 EAST MEDICAL CENTER DR",
"address_2": "2ND FLOOR TAUBMAN CTR RECP F",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481090332",
"telephone_number": "734-936-5738"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "CHARLES",
"middle_name": "RODNEY",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601001292",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2656213",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ann Arbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.