Individual provider Active NPI

Nicholas C. Moore, DPT, OCS, FAAOMPT

  • Physical Therapist
  • Sterling, CO
National Provider Identifier
1508203118
Registry record updated Nov 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PTL0013585 Issued in CO
Practice address
1402 S 3Rd Ave
Sterling, CO 80751-4650
Phone
(970) 526-6038
Fax
(970) 526-6038
NPI assigned
May 23, 2013
Last updated
Nov 15, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PTL0013585 CO Primary

Addresses

Primary practice location

1402 S 3Rd Ave
Sterling, CO 80751-4650

Mailing address

1402 S 3Rd Ave
Sterling, CO 80751-4650
Phone (970) 526-6038

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211209000954 CO Practitioner - Physical Therapist in Private Practice 5799927000 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Resilient Physiotherapy and Performance, PLLCGroup PAC ID 8022408855, 2 clinicians

Practice addresses (Care Compare)

1402 S 3Rd Ave
Sterling, CO 80751-4650
Phone (970) 526-6038

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PTL0013585COMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Resilient Physiotherapy and Performance, LLC Physical Therapist CurrentSince Nov 15, 2021 Accepting new patients
Apt West Wichita, LLC Physical Therapist Past Accepting new patients
Advanced PT McPherson LLC Physical Therapist Past Accepting new patients
Advanced PT Pca, LLC Physical Therapist Past Accepting new patients

Locations

1402 S 3rd Ave
Sterling, CO 80751
Phone (970) 526-6038

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": "1369267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636934400000",
    "number": "1508203118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1402 S 3RD AVE",
            "city": "STERLING",
            "state": "CO",
            "postal_code": "807514650",
            "telephone_number": "970-526-6038",
            "fax_number": "970-526-6038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1402 S 3RD AVE",
            "city": "STERLING",
            "state": "CO",
            "postal_code": "807514650",
            "telephone_number": "970-526-6038",
            "fax_number": "970-526-6038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "NICHOLAS",
        "middle_name": "C.",
        "credential": "DPT, OCS, FAAOMPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-05-23",
        "last_updated": "2021-11-15",
        "certification_date": "2021-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "PTL0013585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sterling, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.