Angelique Denise Moore, FNP-C, RN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704195802NSA17232 Issued in MI

Practice address

29205 Glencastle CT
Farmington Hills, MI 48336-1416

Phone

(248) 470-2120

Fax

(248) 470-2120

NPI assigned

Mar 10, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Keri Heart Inc

  • Internal Medicine Physician
  • Detroit, MI
  • NPI 1871281121

  MI, Single Specialty

  Medicare reassignment Care Compare group NPD
• Curana Health of Michigan PLLC

  • Internal Medicine Physician
  • Detroit, MI
  • NPI 1659921278

  MI, Single Specialty

  Medicare reassignment NPD
• Vpa PC

  • Family Medicine Physician
  • Portage, MI
  • NPI 1669091864

  MI, Single Specialty

  Medicare reassignment NPD
• Infinite Medical PC

  • Family Medicine Physician
  • Bristol, RI
  • NPI 1407483175

  MI, Single Specialty

  Medicare reassignment NPD
• Medical Director Services PC

  • Geriatric Medicine (Internal Medicine) Physician
  • Princess Anne, MD
  • NPI 1871955807

  MI, Single Specialty

  Medicare reassignment NPD
• Woodland Urgent Care LLC

  • Family Medicine Physician
  • Detroit, MI
  • NPI 1841299435

  Single Specialty

  NPD
• Vpa PC

  • Family Medicine Physician
  • Brentwood, TN
  • NPI 1578363362

  Single Specialty

  NPD
• Healthland Housecall Services LLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Warren, MI
  • NPI 1760029581

  Single Specialty

  NPD (past)
• Michigan Sports and Spine Center PC

  • Physical Medicine & Rehabilitation Physician
  • Livonia, MI
  • NPI 1205887262

  Single Specialty

  NPD (past)
• Summit of Detroit, P.C.

  • Obstetrics & Gynecology Physician
  • Detroit, MI
  • NPI 1558497008

  Registered Nurse

  NPD (past)
• Summit Womens Center

  • Case Management Agency
  • Detroit, MI
  • NPI 1730456922
  NPD (past)

Specialty

Nurse Practitioner

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Keri Heart Inc 2 clinicians

Practice addresses (Care Compare)

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

{
    "created_epoch": "1268179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1477876019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29205 GLENCASTLE CT",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483361416",
            "telephone_number": "248-943-4535",
            "fax_number": "248-552-8144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29205 GLENCASTLE CT",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483361416",
            "telephone_number": "248-470-2120",
            "fax_number": "248-470-2120"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15801 W McNichols Rd",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482353543",
            "country_code": "US",
            "telephone_number": "313-272-8450",
            "fax_number": "313-272-8455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "ANGELIQUE",
        "middle_name": "DENISE",
        "name_prefix": "Mrs.",
        "credential": "FNP-C, RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-03-10",
        "last_updated": "2022-07-21",
        "certification_date": "2020-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704195802",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704195802NSA17232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lelani Moore-Gourdine
• Ahna Moore
• Aleixis Moore
• Alexis Moore
• Aminah Moore
• Annastacia Moore
• Aquandra Moore
• Aria Moore
• Ashia Moore
• Ashton Moore

• All providers in Farmington Hills, MI
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.