Micah Robert Moore, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

3323 Issued in WV

Practice address

400 N Jefferson St
Lewisburg, WV 24901

Phone

(304) 645-3220

Fax

(304) 647-1273

NPI assigned

Jun 18, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Hospitalist

Education

West Virginia School of Osteopathic Medicine, 2017

Medicare assignment

May accept Medicare assignment

Group practices

Southeastern Hospitalist Services PCGroup PAC ID 3476855420, 301 clinicians

Providence House Calls LLCGroup PAC ID 1759528250, 20 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Hospice LLC Hospice, Rock Hill, SC, CCN 421605
• Piedmont Medical Center Hospital, Rock Hill, SC, CCN 420002

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• Providence House Calls LLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Rock Hill, SC
  • NPI 1689912495

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Southeastern Hospitalist Services PC

  • Hospitalist Physician
  • Myrtle Beach, SC
  • NPI 1003280108

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Amisub of South Carolina, Inc.

  • General Acute Care Hospital
  • Rock Hill, SC
  • NPI 1457382483
  NPD (past)

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

• Amisub of South Carolina, Inc.

  • General Acute Care Hospital
  • Rock Hill, SC
  • NPI 1457382483
  Care Compare affiliation
• Providence Care LLC

  • Community Based Hospice Care Agency
  • Rock Hill, SC
  • NPI 1891005104
  Care Compare affiliation

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

{
    "created_epoch": "1497744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610496000000",
    "number": "1346770872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 MAPLEWOOD AVE",
            "city": "RONCEVERTE",
            "state": "WV",
            "postal_code": "249708016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N JEFFERSON ST",
            "city": "LEWISBURG",
            "state": "WV",
            "postal_code": "24901",
            "telephone_number": "304-645-3220",
            "fax_number": "304-647-1273"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Hoylman Dr",
            "address_purpose": "LOCATION",
            "city": "Gassaway",
            "state": "WV",
            "postal_code": "266249318",
            "country_code": "US",
            "telephone_number": "304-364-5156",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MICAH",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-18",
        "last_updated": "2021-01-13",
        "certification_date": "2021-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "WV",
            "license": "3323",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "3323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmoore133947@direct.wvuhsdirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "100 Hoylman Dr",
            "city": "Gassaway",
            "state": "WV",
            "country_code": "US",
            "postal_code": "266249318",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Preston Dyer Modlin, ED.D.
• Sabrina Zara Mohsin
• Heidi Molga
• Travis Edward Mollohan, DPT
• Amber Lynn Moody Lopez
• Shawnda R Moore
• Hunter Morris
• Kayla Rene Morris
• Andrea L Morrison
• Mountain Anesthesia, LLC

• Family Medicine Physician in Lewisburg, WV
• Providers in Lewisburg, WV by specialty
• Family Medicine Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2021; 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.