Charles K Moore, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

50644 Issued in WV

Practice address

2828 1St Ave
Suite 510
Huntington, WV 25702-1236

Phone

(304) 399-7533

Fax

(304) 399-7507

NPI assigned

Mar 1, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WV

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, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St. Mary'S Medical Management, LLCGroup PAC ID 5890897151, 92 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Interoperability endpoints

• Direct secure messaging: kevin.moore@smmm.cernerdirect.com

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.

• St. Mary'S Medical Management, LLC

  • Family Medicine Physician
  • Huntington, WV
  • NPI 1922155217
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619049600000",
    "number": "1447227285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4190",
            "city": "BARBOURSVILLE",
            "state": "WV",
            "postal_code": "255044190",
            "telephone_number": "304-399-4405",
            "fax_number": "304-399-2526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2828 1ST AVE",
            "address_2": "SUITE 510",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257021236",
            "telephone_number": "304-399-7533",
            "fax_number": "304-399-7507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "CHARLES",
        "middle_name": "K",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-01",
        "last_updated": "2021-04-22",
        "certification_date": "2021-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "4411P",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WV",
            "license": "50644",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100008460",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00892178",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2654266",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810004812",
            "state": "WV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kevin.moore@smmm.cernerdirect.com",
            "affiliation": "N",
            "address_1": "2828 1st Ave",
            "address_2": "Suite 510",
            "city": "Huntington",
            "state": "WV",
            "country_code": "US",
            "postal_code": "257021236",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Alicia Michelle Moore
• Amy Moore, RN
• Anna Moore
• Ashley Bryanna Moore
• Cassie Moore
• Christian Moore
• Curtis Ann Moore, LPC, LSW
• Dennis Robert Moore, APRN-CNP
• Hannah Nykole Moore, MA
• Hannah Rebekah Moore, APRN

• Family Nurse Practitioner in Huntington, WV
• Providers in Huntington, WV by specialty
• Family Nurse Practitioner in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2021; 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.