Individual provider Active NPI

Kellie Moore

  • Pediatrics Physician
  • Albuquerque, NM
National Provider Identifier
1437544079
Registry record updated Jun 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
RS2015-0351 Issued in NM
Practice address
Msc10 5590 1 University of New Mexico
Albuquerque, NM 87131-0001
Phone
(505) 272-3120
NPI assigned
Mar 31, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NM
Pediatrics Physician 208000000X RS2015-0351 NM Primary

Addresses

Primary practice location

Msc10 5590 1 University of New Mexico
Albuquerque, NM 87131-0001

Mailing address

933 Bradbury Dr SE
Suite 2222
Albuquerque, NM 87106-4374
Phone (505) 272-3120

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20221216000460 CA Practitioner - AnesthesiologyPractitioner - Pediatric Medicine 5193039352 Reassigns benefits to 3 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University Anesthesia Medical Group CurrentSince Sep 26, 2022 Accepting new patients
UCSF Medical Group Business Services CurrentSince Sep 26, 2022 Accepting new patients
University of California San Francisco Pediatrics Current Accepting new patients
UCSF Medical Group Business Services CurrentSince Sep 26, 2022 Accepting new patients
University of California San Francisco CurrentSince Sep 26, 2022 Accepting new patients
University of California San Francisco CurrentSince Sep 26, 2022 Accepting new patients
UCSF Medical Center Past Accepting new patients
University of California San Francisco Medical Center Past Accepting new patients

Locations

3100 San Pablo Ave
Berkeley, CA 94702
Phone (510) 985-5020

747 52nd St
Oakland, CA 94609
Phone (510) 428-3070

2001 The Embarcadero
Ofc Of
San Francisco, CA 94143
Phone (628) 224-5503

400 Parnassus Ave
#A632
San Francisco, CA 94143
Phone (415) 473-1000

521 Parnassus Ave
Fl 4
San Francisco, CA 94143
Phone (415) 476-9035

505 Parnassus Ave
San Francisco, CA 94143
Phone (415) 476-9058

2330 Post St
San Francisco, CA 94115
Phone (415) 502-4444

521 Parnassus Ave
Rm 4615
San Francisco, CA 94143

Interoperability endpoints

  • Direct secure messaging: kmoore254493@direct-ucsfmedicalcenter.org

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1427760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434758400000",
    "number": "1437544079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "933 BRADBURY DR SE",
            "address_2": "SUITE 2222",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871064374",
            "telephone_number": "505-272-3120",
            "fax_number": "505-272-8060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MSC10 5590 1 UNIVERSITY OF NEW MEXICO",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871310001",
            "telephone_number": "505-272-3120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "KELLIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-31",
        "last_updated": "2015-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NM",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NM",
            "license": "RS2015-0351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.