Individual provider Active NPI

Gloria Z. Moore, D.C.

  • Chiropractor
  • St Augustine, FL
National Provider Identifier
1508814856
Registry record updated Jan 14, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH6819 Issued in FL
Practice address
101 Whitehall Dr Ste 102
Suite a
St Augustine, FL 32086-5268
Phone
(904) 794-0909
Fax
(904) 825-0240
NPI assigned
May 5, 2006
Last updated
Jan 14, 2009By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH6819 FL Primary

Addresses

Primary practice location

101 Whitehall Dr Ste 102
Suite a
St Augustine, FL 32086-5268

Mailing address

101 Whitehall Dr Ste 102
St Augustine, FL 32086-5268
Phone (904) 794-0909

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090320000310 FL Practitioner - Chiropractic 3971660895 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

101 Whitehall Dr
Suite 102
St Augustine, FL 32086-5268
Phone (904) 794-0909

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CH6819FLMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Gloria Z. Moore D.C., P.a. Chiropractor CurrentSince Nov 26, 2008 Accepting new patients

Locations

101 Whitehall Dr
Ste 102
St Augustine, FL 32086
Phone (904) 794-0909

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, 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": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1231891200000",
    "number": "1508814856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 WHITEHALL DR STE 102",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320865268",
            "telephone_number": "904-794-0909",
            "fax_number": "904-825-0240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 WHITEHALL DR STE 102",
            "address_2": "SUITE A",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320865268",
            "telephone_number": "904-794-0909",
            "fax_number": "904-825-0240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "GLORIA",
        "middle_name": "Z.",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-05",
        "last_updated": "2009-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH6819",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2009; 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.