Individual provider Active NPI

Paul Benjamin Moore, MSN, APRN, CPNP

  • Nurse Practitioner
  • Akron, OH
National Provider Identifier
1457906737
Registry record updated Apr 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APRN.CNP.025361 Issued in OH
Practice address
1 Perkins SQ
Akron, OH 44308-1063
Phone
(330) 543-8050
Fax
(330) 543-8054
NPI assigned
Aug 5, 2019
Last updated
Apr 7, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X APRN.CNP.025361 OH
Nurse Practitioner 363L00000X APRN.CNP.025361 OH Primary

Addresses

Primary practice location

1 Perkins SQ
Akron, OH 44308-1063

Mailing address

1 Perkins SQ
Akron, OH 44308-1063
Phone (330) 543-8050

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pmoore27867@direct.chmca.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20191227001486 OH Practitioner - Nurse Practitioner 4082048053 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Certified Pediatric Nurse Practitioner, Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN.CNP.025361OHMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children's Hospital Medical Center of Akron Current Accepting new patients
Children's Hospital Medical Center of Akron CurrentSince Oct 28, 2019 Accepting new patients
Children's Hospital Medical Center of Akron Pediatrics CurrentSince Oct 28, 2019 Accepting new patients
Akron Children's Hospital Current Accepting new patients

Locations

1 Perkins Sq
Akron, OH 44308
Phone (330) 543-8050

Interoperability endpoints

  • Direct secure messaging: pmoore27867@direct.chmca.org

Organizations & group practices 4

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": "1564963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617753600000",
    "number": "1457906737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PERKINS SQ",
            "city": "AKRON",
            "state": "OH",
            "postal_code": "443081063",
            "telephone_number": "330-543-8050",
            "fax_number": "330-543-8054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PERKINS SQ",
            "city": "AKRON",
            "state": "OH",
            "postal_code": "443081063",
            "telephone_number": "330-543-8050",
            "fax_number": "330-543-8054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "PAUL",
        "middle_name": "BENJAMIN",
        "name_prefix": "Mr.",
        "credential": "MSN, APRN, CPNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-05",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "APRN.CNP.025361",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "APRN.CNP.025361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pmoore27867@direct.chmca.org",
            "affiliation": "N",
            "address_1": "1 Perkins Sq",
            "city": "Akron",
            "state": "OH",
            "country_code": "US",
            "postal_code": "443081063",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Akron, OH

Sources for this page

Verify at the official NPI Registry.