Joanna Leigh Moore, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71009786A Issued in IN

Practice address

661 E Main St
Peru, IN 46970-2662

Phone

(765) 472-2519

Fax

(765) 400-4465

NPI assigned

Dec 20, 2019

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

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, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Indiana Health Centers IncGroup PAC ID 3971599473, shared by 16 NPIs, 63 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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 and National Provider Directory roles.

• Complexcare Medical Group Midwest M PLLC

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1528851607
  NPD
• Indiana Health Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Peru, IN
  • NPI 1336373190
  NPD (past)

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

{
    "created_epoch": "1576800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675814400000",
    "number": "1326686395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8003 CASTLEWAY DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462501946",
            "telephone_number": "175-761-3353",
            "fax_number": "317-343-6562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "661 E MAIN ST",
            "city": "PERU",
            "state": "IN",
            "postal_code": "469702662",
            "telephone_number": "765-472-2519",
            "fax_number": "765-400-4465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "JOANNA",
        "middle_name": "LEIGH",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-20",
        "last_updated": "2023-02-08",
        "certification_date": "2023-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "28164395A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71009786A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300036259",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Midwest Eye Consultants, P.C.
• John S Miles, D.P.M.
• Rebecca Lyn Millard, RN
• Kimberley Lyn Miller
• Lewis John Millsap III, MA
• James Mulis
• Michael Mull, MD
• Erin Mulloy, BS
• Angela Kay Musall, BA
• Sara Jayne Musselman, DDS

• Family Nurse Practitioner in Peru, IN
• Providers in Peru, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2023; 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.