Individual provider Active NPI

Kevin Moore, MD

  • Anesthesiology Physician
  • Marietta, OH
National Provider Identifier
1407853047
Registry record updated Feb 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
35064203 Issued in OH
Practice address
401 Matthew St
Marietta, OH 45750-1635
Phone
(740) 568-5427
Fax
(740) 376-5073
NPI assigned
Jun 28, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 2, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 35064203 OH Primary

Addresses

Primary practice location

401 Matthew St
Marietta, OH 45750-1635

Mailing address

11490 Springfield Pike
Cincinnati, OH 45246-3524
Phone (513) 672-3309

Other practice location 1

1106 Colegate Dr
Marietta, OH 45750-1323
Phone (740) 568-2000

Other practice location 2

800 Forest Ave
Zanesville, OH 43701-2882
Phone (513) 672-3309 ext. 228

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address anesthesia.providers@mmhs.medicity.net
Direct Messaging Address anesthesia.providers@mmhs.medicity.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20130214000092 OH Practitioner - Anesthesiology 2860425824 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Ohio State University College of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Marietta Memorial HospitalGroup PAC ID 8224928965, 387 clinicians

Practice addresses (Care Compare)

401 Matthew St
Marietta, OH 45750-1635
Phone (740) 374-1623

Hospital & facility affiliations

  • Marietta Memorial Hospital Hospital, Marietta, OH, CCN 360147

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35064203OHMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Marietta Memorial Hospital CurrentSince Jan 1, 2022 Accepting new patients
Marietta Memorial Hospital CurrentSince Jan 1, 2022 Accepting new patients
Daniel L French PSC Past Accepting new patients
General Anesthesia Services Inc Anesthesiology Past Accepting new patients

Locations

401 Matthew St
Marietta, OH 45750
Phone (740) 374-1400

701 Hildreth Ln
Marietta, OH 45750
Phone (740) 371-7194

1106 Colegate Dr
Marietta, OH 45750
Phone (740) 374-7700

400 Matthew St
Ste 101
Marietta, OH 45750
Phone (740) 568-4150

Organizations & group practices 5

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 1

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": "1119916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643760000000",
    "number": "1407853047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11490 SPRINGFIELD PIKE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452463524",
            "telephone_number": "513-672-3309",
            "fax_number": "513-672-3323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 MATTHEW ST",
            "city": "MARIETTA",
            "state": "OH",
            "postal_code": "457501635",
            "telephone_number": "740-568-5427",
            "fax_number": "740-376-5073"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1106 Colegate Dr",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "OH",
            "postal_code": "457501323",
            "country_code": "US",
            "telephone_number": "740-568-2000",
            "fax_number": "740-568-2094",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "800 Forest Ave",
            "address_purpose": "LOCATION",
            "city": "Zanesville",
            "state": "OH",
            "postal_code": "437012882",
            "country_code": "US",
            "telephone_number": "513-672-3309 x228",
            "fax_number": "513-672-3323",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "KEVIN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-28",
        "last_updated": "2022-02-02",
        "certification_date": "2022-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OH",
            "license": "35064203",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "anesthesia.providers@mmhs.medicity.net",
            "affiliation": "N",
            "address_1": "401 Matthew St",
            "city": "Marietta",
            "state": "OH",
            "country_code": "US",
            "postal_code": "457501635",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "anesthesia.providers@mmhs.medicity.net",
            "affiliation": "N",
            "address_1": "1106 Colegate Dr",
            "city": "Marietta",
            "state": "OH",
            "country_code": "US",
            "postal_code": "457501323",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marietta, OH

Sources for this page

Verify at the official NPI Registry.