Justin Anthony Moore

Primary specialty

PsychologistTaxonomy code 103T00000X

License

3606-57 Issued in WI

Practice address

400 Central Ave Ste 220
Northfield, IL 60093-3024

Phone

(847) 996-9994

NPI assigned

Jun 22, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Unify Counseling IncGroup PAC ID 2264831312, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Unify Counseling Inc

  • Clinic/Center
  • Northfield, IL
  • NPI 1942899646

  Psychologist

  Medicare reassignment Care Compare group NPD
• DPT Holdings PLLC

  • Physical Therapist
  • Plainfield, IL
  • NPI 1689648602
  NPD (past)

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

{
    "created_epoch": "1466553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701388800000",
    "number": "1487005393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1189 WILMETTE AVE STE 263",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600912719",
            "telephone_number": "224-216-4443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 CENTRAL AVE STE 220",
            "city": "NORTHFIELD",
            "state": "IL",
            "postal_code": "600933024",
            "telephone_number": "847-996-9994"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9751 Watts Rd",
            "address_purpose": "LOCATION",
            "city": "Verona",
            "state": "WI",
            "postal_code": "535939377",
            "country_code": "US",
            "telephone_number": "973-851-7255",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "JUSTIN",
        "middle_name": "ANTHONY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-22",
        "last_updated": "2023-12-01",
        "certification_date": "2023-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "3606-57",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alpa Vaghasiya Modi, DO
• Barbara Mokrzycka-Pys, D.C.
• Samuel Moltz, M.D.
• Mona H Berman Ma, LTD
• Carolina Montoya
• Kelsey Lynn Mora, CCLS, LCPC
• Camilo Morales Hormiga
• Kathryn Moreno
• Alexander Morrill, M.D.
• Angela Ak Muganwa

• Psychologist in Northfield, IL
• Providers in Northfield, IL by specialty
• Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 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.
• 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.