Active NPI
Benjamin William Moore, MD
- Surgery Physician
- Oklahoma City, OK
National Provider Identifier
1346079654
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 45588
- Practice address
- 1100 N Lindsay Ave
Oklahoma City, OK 73104-5410 - Phone
- (405) 271-4000
- NPI assigned
- Jul 26, 2024
- 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 45588 | OK | Primary |
Addresses
Primary practice location
1100 N Lindsay Ave
Oklahoma City, OK 73104-5410
Mailing address
2057 Mattern Dr
Oklahoma City, OK 73118-1911
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250804004006 | OK | Order and Referring Only - General Surgery | 9739697368 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 45588 | OK | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747267200000",
"number": "1346079654",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2057 MATTERN DR",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731181911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 N LINDSAY AVE",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731045410",
"telephone_number": "405-271-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "BENJAMIN",
"middle_name": "WILLIAM",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-07-26",
"last_updated": "2025-05-15",
"certification_date": "2025-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "OK",
"license": "45588",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2025; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.