Shane Moore

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP139172 Issued in TX

Practice address

7030 New Sanger Ave Ste 204
Waco, TX 76712-4074

Phone

(254) 245-9175

Fax

(254) 213-7771

NPI assigned

Nov 19, 2018

Last updated

Oct 14, 2020By 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

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

May accept Medicare assignment

Group practices

Legacy Urgent Care PAGroup PAC ID 3072679828, 157 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shane.moore@ipap-tx.direct.office.nextgen.com
• Direct secure messaging: smoore580767@direct.sw.org

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.

• Legacy Urgent Care, PA

  • Urgent Care Clinic/Center
  • Frisco, TX
  • NPI 1568622272
  Medicare reassignment Care Compare group NPD
• Healthnow Urgent Care Inc

  • Urgent Care Clinic/Center
  • Whitney, TX
  • NPI 1447779152
  Medicare reassignment NPD
• Premier Physicians-II, P.a.

  dba Premier Urgent Care Plus

  • Urgent Care Clinic/Center
  • Woodway, TX
  • NPI 1801204656
  Medicare reassignment NPD
• Frisco Emergency Medicine Associates, PA

  • Emergency Care Clinic/Center
  • Frisco, TX
  • NPI 1467612176
  NPD (past)
• Premier Physicians-1 PA

  • Emergency Medical Services (Emergency Medicine) Physician
  • Woodway, TX
  • NPI 1578971834
  NPD (past)

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

{
    "created_epoch": "1542585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602633600000",
    "number": "1417426529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11538",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765471538",
            "telephone_number": "254-245-9177",
            "fax_number": "254-245-9178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7030 NEW SANGER AVE STE 204",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767124074",
            "telephone_number": "254-245-9175",
            "fax_number": "254-213-7771"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2304 Marketplace Dr",
            "address_purpose": "LOCATION",
            "city": "Waco",
            "state": "TX",
            "postal_code": "767112467",
            "country_code": "US",
            "telephone_number": "254-202-7300",
            "fax_number": "254-202-7350",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "SHANE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-11-19",
        "last_updated": "2020-10-14",
        "certification_date": "2020-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP139172",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "AP139172",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "smoore580767@direct.sw.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2304 Marketplace Dr",
            "city": "Waco",
            "state": "TX",
            "country_code": "US",
            "postal_code": "767112467",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Joseph Scott Moore, MS, ATC
• Macasiana Ashanti Moore
• Mark K Moore, MD
• Nickie Michelle Moore
• Rachel Moore, D.C.
• Micah Bonnett Mordecai, D.C.
• Espiridion Moreno Jr., LMSW
• Maria Reyna Moreno, LVN
• Matthew Michael Morgan-Freeland, DC
• Anna Elizabeth Morgan, LMFT

• Family Nurse Practitioner in Waco, TX
• Providers in Waco, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2020; 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.