Nicole M Moore, APN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209-014814 Issued in IL

Practice address

3401 N Perryville Rd
Rockford, IL 61114-8011

Phone

(815) 971-2000

Fax

(815) 971-9570

NPI assigned

Jul 19, 2016

Last updated

Mar 14, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Saint Anthony Medical CenterGroup PAC ID 5496654006, 45 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Anthony Medical Center Hospital, Rockford, IL, CCN 140233

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Saint Anthony Medical Center

  dba OSF Saint Anthony Medical Center

  • Hematology & Oncology Physician
  • Rockford, IL
  • NPI 1942248802
  Medicare reassignment Care Compare group NPD
• Osf Multi-Specialty Group

  • Internal Medicine Physician
  • Peoria, IL
  • NPI 1922445527
  Medicare reassignment NPD
• Rockford Health Physicians

  dba Mercyhealth Physicians

  • Multi-Specialty Clinic/Center
  • Rockford, IL
  • NPI 1043242886
  Medicare reassignment NPD
• Saint Anthony Medical Center

  dba OSF Saint Anthony Medical Center

  • Emergency Medicine Physician
  • Rockford, IL
  • NPI 1326086281
  NPD
• Saint Anthony Medical Center

  dba OSF Healthcare - Medical Group - Rock Cut

  • Rural Health Clinic/Center
  • Loves Park, IL
  • NPI 1558067975
  NPD
• Central PA Pharmacy LLC.

  dba patton pharmacy and v&s variety

  • Community/Retail Pharmacy
  • Patton, PA
  • NPI 1578541413
  NPD
• Saint Anthony Medical Center

  dba OSF Saint Anthony Medical Center

  • General Acute Care Hospital
  • Rockford, IL
  • NPI 1790739977
  NPD (past)
• Swedishamerican Hospital

  dba SwedishAmerican Medical Group

  • Family Medicine Physician
  • Rockford, IL
  • NPI 1962451732
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Saint Anthony Medical Center

  dba OSF Saint Anthony Medical Center

  • General Acute Care Hospital
  • Rockford, IL
  • NPI 1790739977
  Care Compare affiliation

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

{
    "created_epoch": "1468886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647216000000",
    "number": "1295188803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 N PERRYVILLE RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611148011",
            "telephone_number": "815-971-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 N PERRYVILLE RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611148011",
            "telephone_number": "815-971-2000",
            "fax_number": "815-971-9570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "NICOLE",
        "middle_name": "M",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-19",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209-014814",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041390820",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Patrick Moore, PA-C
• Kelly James Moore, DDS
• Lily Moore, DPT
• Lindsay Danielle Moore, DMD
• Michelle Moore
• Ryan Thomas Moore, DMD
• S Christopher Moore, M.D.
• Tavares Moore
• Tom Harold Moore, D.D.S.
• Willard D. Moore, MD

• Family Nurse Practitioner in Rockford, IL
• Providers in Rockford, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2022; 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.

Verify at the official NPI Registry.