NPIMap

Individual provider Active NPI

Maribeth Dudley Moore, D.O.

  • Family Medicine Physician
  • Conroe, TX
National Provider Identifier
1376530758
Registry record updated Apr 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
K0529 Issued in TX
Practice address
800 Riverwood CT
Suite 105
Conroe, TX 77304-2890
Phone
(936) 760-4454
Fax
(936) 760-4415
NPI assigned
Sep 30, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 13, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X K0529 TX Primary

Addresses

Primary practice location

800 Riverwood CT
Suite 105
Conroe, TX 77304-2890

Mailing address

800 Riverwood CT
Suite 105
Conroe, TX 77304-2890
Phone (936) 760-4454

Other identifiers 1

IdentifierTypeStateIssuer
046741706MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101006000783 TX Practitioner - Family Practice 2062400369 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of North Texas HSC, College of Osteopathic Med, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Family Healthcare Affiliates PLLCGroup PAC ID 7214925510, 2 clinicians

Practice addresses (Care Compare)

800 Riverwood CT
Suite 105
Conroe, TX 77304-2824
Phone (936) 760-4454

Hospital & facility affiliations

  • Aspire Hospital Hospital, Conroe, TX, CCN 670093
  • HCA Houston Healthcare Conroe Hospital, Conroe, TX, CCN 450222
  • Memorial Hermann Hospital System Hospital, Houston, TX, CCN 450184
  • Tops Surgical Specialty Hospital Hospital, Houston, TX, CCN 450774
  • Houston Methodist the Woodlands Hospital Hospital, The Woodlands, TX, CCN 670122

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
K0529TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Healthcare Affiliates PLLC Family Medicine CurrentSince Aug 13, 2002 Accepting new patients

Locations

800 Riverwood Ct
Ste 105
Conroe, TX 77304
Phone (936) 760-4454

Organizations & group practices 1

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.

Hospital & facility affiliations 11

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": "1128038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302652800000",
    "number": "1376530758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 RIVERWOOD CT",
            "address_2": "SUITE 105",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773042890",
            "telephone_number": "936-760-4454",
            "fax_number": "936-760-4415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 RIVERWOOD CT",
            "address_2": "SUITE 105",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773042890",
            "telephone_number": "936-760-4454",
            "fax_number": "936-760-4415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MARIBETH",
        "middle_name": "DUDLEY",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-09-30",
        "last_updated": "2011-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "K0529",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046741706",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conroe, TX

Sources for this page

Verify at the official NPI Registry.