Roger T Moore, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

01058554A Issued in IN

Practice address

111 N Nappanee St
Elkhart, IN 46514-1957

Phone

(574) 522-0265

Fax

(574) 293-2855

NPI assigned

Apr 21, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Texas Tech University Health Science Center School of Medicine, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dermatology and Skin Surgery CenterGroup PAC ID 2668467838, 29 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dermatology & Skin Surgery Center

  • Specialist
  • Battle Creek, MI
  • NPI 1083649628

  IN

  Medicare reassignment Care Compare group NPD
• Enos Dermatopathology PLLC

  • Dermatopathology Physician
  • Amarillo, TX
  • NPI 1538813696
  NPD (past)

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

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366408080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 N NAPPANEE STREET",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "46514",
            "telephone_number": "574-522-0265",
            "fax_number": "574-293-2855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 N NAPPANEE ST",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465141957",
            "telephone_number": "574-522-0265",
            "fax_number": "574-293-2855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "ROGER",
        "middle_name": "T",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IN",
            "license": "01058554A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Khalid Mohamed, MD
• Rabia Mohammad, M.D.
• Shoeb Mohammed, M.D.
• Chad Gary Moody, CRNA
• Susan Marie Moore-Riesbeck, D.O.
• Tatyana Moore
• Danielle Morales-Funez
• Alexia Morales
• Laarni May G Moreno, M.D.
• Thomas P. Moretti, PA-C

• Dermatology Physician in Elkhart, IN
• Providers in Elkhart, IN by specialty
• Dermatology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.