NPIMap

Individual provider Active NPI

Richard Charles Moore, M.D.

  • Family Medicine Physician
  • Hailey, ID
National Provider Identifier
1457481343
Registry record updated Oct 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
6741 Issued in MT
Practice address
309 East Spruce
Hailey, ID 83333-3530
Phone
(208) 578-2089
NPI assigned
Mar 7, 2007
Last updated
Oct 29, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 44228 MN
Family Medicine Physician 207Q00000X 6741 MT Primary

Addresses

Primary practice location

309 East Spruce
Hailey, ID 83333-3530

Mailing address

PO Box 3530
Hailey, ID 83333-3530

Other practice location 1

1120 E 34th St
Hibbing, MN 55746-2909
Phone (218) 362-7100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
6741MTMDPharmacist
6280AKMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
US Dept of HHS Family Medicine Past Accepting new patients
Acoma-Canoncito-Laguna Indian Health Center Past Accepting new patients
Fairview Clinics Past Accepting new patients
Siouxland Anesthesiology, LTD Past Accepting new patients
Fairview Health Services Past Accepting new patients
Haaku Health Past Accepting new patients

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540771200000",
    "number": "1457481343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3530",
            "city": "HAILEY",
            "state": "ID",
            "postal_code": "833333530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 EAST SPRUCE",
            "city": "HAILEY",
            "state": "ID",
            "postal_code": "833333530",
            "telephone_number": "208-578-2089"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1120 E 34th St",
            "address_purpose": "LOCATION",
            "city": "Hibbing",
            "state": "MN",
            "postal_code": "557462909",
            "country_code": "US",
            "telephone_number": "218-362-7100",
            "fax_number": "218-362-7131",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "RICHARD",
        "middle_name": "CHARLES",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-07",
        "last_updated": "2018-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "44228",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MT",
            "license": "6741",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hailey, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.