John Wayne Moore, CRNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

1-087639 Issued in AL

Practice address

136 Commerce Ave
Valley Head, AL 35989-2421

Phone

(256) 674-1052

Fax

(256) 674-1054

NPI assigned

Apr 4, 2013

Last updated

Apr 21, 2023By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AL

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

Specialty

Nurse Practitioner

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: john.w.moore@ndpcl-al.direct.office.nextgen.com

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.

• North Dekalb Primary Care, LLC

  • Family Medicine Physician
  • Valley Head, AL
  • NPI 1851898449
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1365033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682035200000",
    "number": "1518200864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 COMMERCE AVE",
            "city": "VALLEY HEAD",
            "state": "AL",
            "postal_code": "359892421",
            "telephone_number": "256-674-1052",
            "fax_number": "256-674-1054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 COMMERCE AVE",
            "city": "VALLEY HEAD",
            "state": "AL",
            "postal_code": "359892421",
            "telephone_number": "256-674-1052",
            "fax_number": "256-674-1054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "JOHN",
        "middle_name": "WAYNE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-04",
        "last_updated": "2023-04-21",
        "certification_date": "2023-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AL",
            "license": "1-087639",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "1-087639",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anesthesia Management Group of North Alabama,LLC
• Chiara Focardi, NBCCH
• Lori B Gustafson, PTA
• Alisha Hamidian, PMHNP-BC
• North Dekalb Primary Care, LLC
• Valley Head Drugs LLC

• Nurse Practitioner in Valley Head, AL
• Providers in Valley Head, AL by specialty
• Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 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.