NPIMap

Individual provider Active NPI

Robert Moore

  • Family Medicine Physician
  • Wyandotte, MI
National Provider Identifier
1336599455
Registry record updated Jun 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101026686 Issued in MI
Practice address
1700 Biddle Ave
Wyandotte, MI 48192-7205
Phone
(734) 284-2026
NPI assigned
Jun 20, 2016
Last updated
Jun 27, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 34.013795 OH
Family Medicine Physician 207Q00000X 5151010031 MI
Family Medicine Physician 207Q00000X 5101026686 MI Primary

Addresses

Primary practice location

1700 Biddle Ave
Wyandotte, MI 48192-7205

Mailing address

26901 Beaumont Blvd Ste 3D
Southfield, MI 48033-3849
Phone (947) 522-1848

Other practice location 1

425 California St Ste 1400
San Francisco, CA 94104-2116
Phone (831) 484-7713

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rmoore4014580@direct.beaumont.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, MI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190820003810 OH Practitioner - Family Practice 5395038269 Reassigns benefits to 1 organization
I20220809000474 MI Practitioner - Family Practice 5395038269 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Osteopathic Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Oakwood Ambulatory LLCGroup PAC ID 1850282914, 271 clinicians

Practice addresses (Care Compare)

1700 Biddle Ave
Wyandotte, MI 48192-7205
Phone (734) 284-2026

201 3Rd St
Suite 200
Belleville, MI 48111-2605
Phone (734) 697-9065

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101026686MIMDFamily Medicine Physician
5151010031MIMDFamily Medicine Physician
34.013795OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Oakwood Ambulatory LLC Family Medicine CurrentSince Aug 8, 2022 Accepting new patients
Oakwood Ambulatory, LLC CurrentSince Aug 8, 2022 Accepting new patients
Mercy Health Physicians-North LLC Family Medicine CurrentSince Jul 31, 2019 Accepting new patients
Mercy Health Physicians - North, LLC CurrentSince Jul 31, 2019 Accepting new patients

Locations

201 3rd St
Ste 200
Belleville, MI 48111
Phone (734) 697-9065

26901 Beaumont Blvd
Ste 3D
Southfield, MI 48033
Phone (947) 522-1860

1700 Biddle Ave
Wyandotte, MI 48192
Phone (734) 284-2026

2200 Jefferson Ave
Fl 5
Toledo, OH 43604
Phone (419) 251-9826

2222 Cherry St
Ste 2300
Toledo, OH 43608
Phone (419) 251-8013

3425 Executive Pkwy
Ste 100
Toledo, OH 43606
Phone (419) 472-1124

Interoperability endpoints

  • Direct secure messaging: rmoore1247573@epic00.shdirect.org

Organizations & group practices 4

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1466380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750982400000",
    "number": "1336599455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD STE 3D",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333849",
            "telephone_number": "947-522-1848",
            "fax_number": "947-522-0307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 BIDDLE AVE",
            "city": "WYANDOTTE",
            "state": "MI",
            "postal_code": "481927205",
            "telephone_number": "734-284-2026"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "425 California St Ste 1400",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941042116",
            "country_code": "US",
            "telephone_number": "831-484-7713",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "ROBERT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-20",
        "last_updated": "2025-06-27",
        "certification_date": "2025-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "34.013795",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5151010031",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101026686",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rmoore4014580@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "1700 Biddle Ave",
            "city": "Wyandotte",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481927205",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wyandotte, MI

Sources for this page

Verify at the official NPI Registry.