NPIMap

Individual provider Active NPI

Rebecca Herold Moore, MD

  • Nephrology Physician
  • Salt Lake City, UT
National Provider Identifier
1477609089
Registry record updated Nov 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
7549060 Issued in UT
Practice address
1160 E 3900 S Ste G200
Salt Lake City, UT 84124-1224
Phone
(801) 268-7766
Fax
(801) 270-3395
NPI assigned
Jan 26, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 44442 CO
Nephrology Physician 207RN0300X N2671 TX
Nephrology Physician 207RN0300X 7549060 UT Primary

Addresses

Primary practice location

1160 E 3900 S Ste G200
Salt Lake City, UT 84124-1224

Mailing address

PO Box 742382
Atlanta, GA 30374-2382

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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
I20110128000368 UT Practitioner - Internal MedicinePractitioner - Nephrology 9234293556 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Nephrology
Education
University of Utah School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Marks Physician Billing LLCGroup PAC ID 6103061072, 8 clinicians

Practice addresses (Care Compare)

1160 E 3900
Suite G200
Salt Lake City, UT 84124-1224
Phone (801) 268-7766

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
63.31 of 100Reported as individual
Quality
0
Promoting interoperability
100
Improvement activities
40
Cost
77.7

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. 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
44442COMDNephrology Physician
N2671TXMDNephrology Physician
7549060UTMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Mark'S Physician Billing, LLC CurrentSince Feb 1, 2013 Accepting new patients
Liberty Dialysis-Woods Cross LLC Past Accepting new patients

Locations

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

1160 E 3900 S
Ste G100
Salt Lake City, UT 84124
Phone (801) 268-7358

1160 E 3900 S
Ste G200
Slc, UT 84124
Phone (801) 268-7766

1200 E 3900 S
Slc, UT 84124
Phone (801) 268-7111

Organizations & group practices 2

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 10

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": "1169769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606435200000",
    "number": "1477609089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 742382",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303742382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1160 E 3900 S STE G200",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241224",
            "telephone_number": "801-268-7766",
            "fax_number": "801-270-3395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "REBECCA",
        "middle_name": "HEROLD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-26",
        "last_updated": "2020-11-27",
        "certification_date": "2020-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CO",
            "license": "44442",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "TX",
            "license": "N2671",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "UT",
            "license": "7549060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.