NPIMap

Individual provider Active NPI

Michael Justin Moore, ARNP

  • Nurse Practitioner
  • Wichita, KS
National Provider Identifier
1427247121
Registry record updated Nov 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
46060 Issued in KS
Practice address
2610 N Woodlawn Blvd
Wichita, KS 67220-2729
Phone
(316) 858-2885
Fax
(316) 858-2530
NPI assigned
Oct 18, 2007
Last updated
Nov 20, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 46060 KS Primary

Addresses

Primary practice location

2610 N Woodlawn Blvd
Wichita, KS 67220-2729

Mailing address

2610 N Woodlawn Blvd
Wichita, KS 67220-2729
Phone (316) 858-2885

Other identifiers 2

IdentifierTypeStateIssuer
200536250CMedicaidKS
P00630601OtherKSRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
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
I20080110000314 KS Practitioner - Nurse Practitioner 5890875231 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Greenwood County HospitalGroup PAC ID 0042129603, 31 clinicians

Practice addresses (Care Compare)

100 W 16TH St
Eureka, KS 67045-1064
Phone (620) 583-5274

6401 Patterson Pkwy
Arkansas City, KS 67005-5701
Phone (620) 442-2500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - Kansas LLC CurrentSince Jan 8, 2018 Accepting new patients
Essential Health & Wellness LLC CurrentSince Mar 25, 2020 Accepting new patients
Greenwood County Hospital CurrentSince Jun 1, 2018 Accepting new patients
Cep America - Kansas LLC Current Accepting new patients
South Central Kansas Regional Medical Center Current Accepting new patients
Greenwood County Hospital CurrentSince Jun 1, 2018 Accepting new patients
South Central Kansas Regional Medical Center CurrentSince Jul 18, 2024 Accepting new patients
Cep America - Kansas LLC CurrentSince Jan 8, 2018 Accepting new patients
Runway Emergency Physicians LLC Past Accepting new patients
Medical Specialties of Kansas, L.L.C. Past Accepting new patients
Galichia Medical Group, P.a. Past Accepting new patients
Emergency Services, PA Past Accepting new patients
South Central Kansas Regional Medical Center Past Accepting new patients
Greenwood County Hospital Past Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

6401 Patterson Pkwy
Arkansas City, KS 67005
Phone (620) 441-5798

6403 Patterson Pkwy
Arkansas City, KS 67005
Phone (620) 442-2500

1001 N Buckner St
Derby, KS 67037
Phone (316) 425-3337

100 W 16th St
Eureka, KS 67045
Phone (620) 583-5274

929 N Saint Francis Ave
Wichita, KS 67214
Phone (316) 291-4396

Interoperability endpoints

  • Direct secure messaging: michael.moore.3@12044.direct.athenahealth.com

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 3

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": "1192665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1227139200000",
    "number": "1427247121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2610 N WOODLAWN BLVD",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672202729",
            "telephone_number": "316-858-2885",
            "fax_number": "316-858-2530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2610 N WOODLAWN BLVD",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672202729",
            "telephone_number": "316-858-2885",
            "fax_number": "316-858-2530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MICHAEL",
        "middle_name": "JUSTIN",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-18",
        "last_updated": "2008-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KS",
            "license": "46060",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200536250C",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00630601",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita, KS

Sources for this page

Verify at the official NPI Registry.