Active NPI
Tanner Mattson Moore, MD
- Family Medicine Physician
- Fort Benning, GA
National Provider Identifier
1467972935
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 2021-00210
- Practice address
- 6600 Van Aalst Blvd BLDG 9250
Fort Benning, GA 31905-2102 - Phone
- (304) 672-3225
- Fax
- (304) 672-3225
- NPI assigned
- Jun 26, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2021-00210 | NC | Primary |
Addresses
Primary practice location
6600 Van Aalst Blvd BLDG 9250
Fort Benning, GA 31905-2102
Mailing address
233 Austin Loop
Fort Benning, GA 31905-7300
Phone (304) 672-3225
Other practice location 1
6600 Van Aalst Blvd
Fort Benning, GA 31905-2102
Phone (304) 672-3225
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jul 1, 2025 through Jul 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clearwater Health DPC, PLLC | Current | Accepting new patients |
Interoperability endpoints
- tmoore89684@capefearvalley.direct-ci.com
Organizations & group practices 1
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.
-
- Diabetology (Family Medicine) Physician
- Apex, NC
- NPI 1720931439
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686787200000",
"number": "1467972935",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "233 AUSTIN LOOP",
"city": "FORT BENNING",
"state": "GA",
"postal_code": "319057300",
"telephone_number": "304-672-3225"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6600 VAN AALST BLVD BLDG 9250",
"city": "FORT BENNING",
"state": "GA",
"postal_code": "319052102",
"telephone_number": "304-672-3225",
"fax_number": "304-672-3225"
}
],
"practiceLocations": [
{
"address_1": "6600 Van Aalst Blvd",
"address_purpose": "LOCATION",
"city": "Fort Benning",
"state": "GA",
"postal_code": "319052102",
"country_code": "US",
"telephone_number": "304-672-3225",
"fax_number": "304-672-3225",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MOORE",
"first_name": "TANNER",
"middle_name": "MATTSON",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-06-26",
"last_updated": "2023-06-15",
"certification_date": "2023-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NC",
"license": "2021-00210",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Benning, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2023; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.