NPIMap

Individual provider Active NPI

Ilyssa Paige Moore, MD

  • Family Medicine Physician
  • Baltimore, MD
National Provider Identifier
1457845547
Registry record updated Sep 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
D95255 Issued in MD
Practice address
201 E University Pkwy
Department of Surgery
Baltimore, MD 21218
Phone
(410) 554-2782
Fax
(443) 444-3430
NPI assigned
Jun 21, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 12, 2022

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
Family Medicine Physician 207Q00000X D95255 MD Primary

Addresses

Primary practice location

201 E University Pkwy
Department of Surgery
Baltimore, MD 21218

Mailing address

201 E University Pkwy
Department of Surgery
Baltimore, MD 21218
Phone (410) 554-2782

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20221130000336 MD Practitioner - Family Practice 9537574371 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Medstar Medical Group II LLCGroup PAC ID 0547413825, 3,726 clinicians

Practice addresses (Care Compare)

810 Bestgate Rd
Annapolis, MD 21401-3648
Phone (410) 573-1110

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Columbia, MD, CCN 217071
  • Amedisys Home Health of Maryland Home health agency, Glen Burnie, MD, CCN 217108
  • Homecall Home health agency, Easton, MD, CCN 217066
  • Medstar Health Home Care Home health agency, Baltimore, MD, CCN 217068
  • The Johns Hopkins Home Health Services, Inc Home health agency, Baltimore, MD, CCN 217081
  • Luminis Health Anne Arundel Medical Center, Inc Hospital, Annapolis, MD, CCN 210023

Merit-based Incentive Payment System (MIPS)

Final score
82.34 of 100Reported as group
Quality
67.9
Promoting interoperability
100
Improvement activities
40
Cost
69.47

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D95255MDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medstar Medical Group II LLC CurrentSince Sep 12, 2022 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Medstar Medical Group II LLC Past Accepting new patients

Locations

810 Bestgate Rd
Annapolis, MD 21401
Phone (410) 573-1110

810 Bestgate Rd
Ste 135
Annapolis, MD 21401
Phone (410) 573-1110

201 E University Pkwy
Baltimore, MD 21218
Phone (410) 554-2651

29955 Three Notch Rd
Ste 100
Charlotte Hall, MD 20622
Phone (301) 290-5300

1406 Crain Hwy S
Ste 106
Glen Burnie, MD 21061
Phone (410) 768-6440

Organizations & group practices 3

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.

Hospital & facility affiliations 7

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": "1529539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662940800000",
    "number": "1457845547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 E UNIVERSITY PKWY",
            "address_2": "DEPARTMENT OF SURGERY",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21218",
            "telephone_number": "410-554-2782",
            "fax_number": "443-444-3430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E UNIVERSITY PKWY",
            "address_2": "DEPARTMENT OF SURGERY",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21218",
            "telephone_number": "410-554-2782",
            "fax_number": "443-444-3430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "ILYSSA",
        "middle_name": "PAIGE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-21",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D95255",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.