Individual provider Active NPI

Mitchell Graham Moore, MD

  • Pediatric Critical Care Medicine Physician
  • Houston, TX
National Provider Identifier
1518463306
Registry record updated Jun 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
V1556 Issued in TX
Practice address
6411 Fannin St
Houston, TX 77030-1501
Phone
(713) 704-4000
Fax
(713) 704-5269
NPI assigned
Apr 2, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD.42645 AL
Pediatrics Physician 208000000X V1556 TX
Pediatric Critical Care Medicine Physician 2080P0203X MD.42645 AL
Pediatric Critical Care Medicine Physician 2080P0203X V1556 TX Primary

Addresses

Primary practice location

6411 Fannin St
Houston, TX 77030-1501

Mailing address

6431 Fannin Street
MSB3.244
Houston, TX 77030-1501
Phone (713) 734-4000

Other practice location 1

1600 7th Ave S
Birmingham, AL 35233-1711
Phone (205) 638-9100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20211018001138 AL Practitioner - Critical Care (Intensivists)Practitioner - Pediatric Medicine 4880092121 Reassigns benefits to 1 organization
I20240620003305 TX Practitioner - Pediatric Medicine 4880092121 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
84.11 of 100Reported as group
Quality
69.15
Promoting interoperability
100
Improvement activities
40
Cost
73.63

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD.42645ALMDPediatric Critical Care Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Alabama Health Services Foundation, PC. CurrentSince Aug 7, 2021 Accepting new patients
University of Alabama Health Services Foundation, PC Pediatrics CurrentSince Aug 7, 2021 Accepting new patients
Ut Physicians CurrentSince Aug 1, 2024 Accepting new patients
Ut Physicians Pediatrics CurrentSince Aug 1, 2024 Accepting new patients
Memorial Hermann Health System Past Accepting new patients

Locations

1600 7th Ave S
Birmingham, AL 35233
Phone (205) 638-9100

6410 Fannin St
Ste 500
Houston, TX 77030
Phone (713) 500-5714

6410 Fannin St
Houston, TX 77030
Phone (713) 500-5800

6411 Fannin St
Houston, TX 77030
Phone (713) 500-6200

6431 Fannin St
#3244
Houston, TX 77030
Phone (713) 500-5727

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1522627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718323200000",
    "number": "1518463306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6431 FANNIN STREET",
            "address_2": "MSB3.244",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770301501",
            "telephone_number": "713-734-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6411 FANNIN ST",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770301501",
            "telephone_number": "713-704-4000",
            "fax_number": "713-704-5269"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1600 7th Ave S",
            "address_purpose": "LOCATION",
            "city": "Birmingham",
            "state": "AL",
            "postal_code": "352331711",
            "country_code": "US",
            "telephone_number": "205-638-9100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MITCHELL",
        "middle_name": "GRAHAM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-02",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AL",
            "license": "MD.42645",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "V1556",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "AL",
            "license": "MD.42645",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "TX",
            "license": "V1556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.