NPIMap

Individual provider Active NPI

Douglas Boylston Moore III, MD

  • Family Medicine Physician
  • Abbeville, SC
National Provider Identifier
1396064804
Registry record updated Jan 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
32634 Issued in SC
Practice address
901 W Greenwood St
Suite 9
Abbeville, SC 29620-5717
Phone
(864) 366-9681
Fax
(864) 366-5600
NPI assigned
May 24, 2010
Last updated
Jan 6, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2023

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 32634 SC Primary

Addresses

Primary practice location

901 W Greenwood St
Suite 9
Abbeville, SC 29620-5717

Mailing address

901 W Greenwood St
Suite 9
Abbeville, SC 29620-5717
Phone (864) 366-9681

Other identifiers 3

IdentifierTypeStateIssuer
326347MedicaidSC
RHC210MedicaidSC
PC3126MedicaidSC

Other names 1

  • Trey Moore Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20110718000800 SC Practitioner - Family PracticePractitioner - Emergency Medicine 0345418349 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of South Carolina School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

420 Thomson Cir
Abbeville, SC 29620-5656
Phone (864) 366-1649

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Edcare Consulting LLC CurrentSince Feb 22, 2018 Accepting new patients
Abbeville County Memorial Hospital CurrentSince Oct 1, 2025 Accepting new patients
Abbeville County Memorial Hospital Family Medicine CurrentSince Jul 18, 2013 Accepting new patients

Locations

420 Thomson Cir
Abbeville, SC 29620
Phone (864) 366-1649

901 W Greenwood St
Ste 9
Abbeville, SC 29620
Phone (864) 366-9681

Interoperability endpoints

  • Direct secure messaging: dmoore524921@selfregional.direct-ci.net

Organizations & group practices 3

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 7

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": "1274659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672963200000",
    "number": "1396064804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 W GREENWOOD ST",
            "address_2": "SUITE 9",
            "city": "ABBEVILLE",
            "state": "SC",
            "postal_code": "296205717",
            "telephone_number": "864-366-9681",
            "fax_number": "864-366-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 W GREENWOOD ST",
            "address_2": "SUITE 9",
            "city": "ABBEVILLE",
            "state": "SC",
            "postal_code": "296205717",
            "telephone_number": "864-366-9681",
            "fax_number": "864-366-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "DOUGLAS",
        "middle_name": "BOYLSTON",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-24",
        "last_updated": "2023-01-06",
        "certification_date": "2023-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "32634",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "326347",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHC210",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PC3126",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TREY",
            "last_name": "MOORE",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Abbeville, SC

Sources for this page

Verify at the official NPI Registry.