NPIMap

Individual provider Active NPI

Candice A. Moore, M.D.

  • Child & Adolescent Psychiatry Physician
  • Nevada, MO
National Provider Identifier
1326013228
Registry record updated Dec 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
R6883 Issued in MO
Practice address
815 S Ash St
Nevada, MO 64772-3222
Phone
(417) 667-8352
NPI assigned
Feb 22, 2006
Last updated
Dec 18, 2013By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 18, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry Physician 2084P0804X R6883 MO Primary

Addresses

Primary practice location

815 S Ash St
Nevada, MO 64772-3222

Mailing address

PO Box 1547
Sedalia, MO 65302-1547

Other identifiers 1

IdentifierTypeStateIssuer
200189009MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090911000553 MO Practitioner - Psychiatry 4183779358 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
R6883MOMDChild & Adolescent Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Nevada City Hospital CurrentSince Jun 4, 2018 Accepting new patients
Nevada City Hospital CurrentSince Jun 4, 2018 Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

800 S Ash St
Nevada, MO 64772
Phone (417) 667-3355

900 S Adams St
Nevada, MO 64772
Phone (417) 667-3355

Ownership & related parties

All facility ownership & control disclosures 7

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Nevada Regional Medical CenterNevada, MO, CCN 260061 Hospital Corporate Director Mar 1, 2016
Nevada Regional Medical CenterNevada, MO, CCN 26S061 Hospital Corporate Officer Mar 1, 2016
Nevada Regional Medical CenterNevada, MO, CCN 26U061 Hospital Corporate Director Mar 1, 2016
NRMC Rich Hill Family Medical ClinicRich Hill, MO, CCN 263425 Rural health clinic Corporate Officer Mar 1, 2016
NRMC Nowcare ClinicNevada, MO, CCN 268645 Rural health clinic Corporate Officer Mar 1, 2016
Nevada Regional Primary Care CenterNevada, MO, CCN 268737 Rural health clinic Corporate Officer Mar 1, 2016
Nevada Medical ClinicNevada, MO, CCN 268793 Rural health clinic Corporate Director Nov 1, 2022

Owned or controlled facilities with NPI records 8

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387324800000",
    "number": "1326013228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1547",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653021547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 S ASH ST",
            "city": "NEVADA",
            "state": "MO",
            "postal_code": "647723222",
            "telephone_number": "417-667-8352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "CANDICE",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-22",
        "last_updated": "2013-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MO",
            "license": "R6883",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200189009",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nevada, MO

Sources for this page

Verify at the official NPI Registry.