NPIMap

Individual provider Active NPI

Brandi N Moore, PA

  • Physician Assistant
  • Max Meadows, VA
National Provider Identifier
1528041381
Registry record updated Jan 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110-002204 Issued in VA
Practice address
245 Fort Chiswell Rd Ste D
Max Meadows, VA 24360-3987
Phone
(276) 613-6991
NPI assigned
Nov 25, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0110-002204 VA
Physician Assistant 363A00000X 0110-002204 VA Primary

Addresses

Primary practice location

245 Fort Chiswell Rd Ste D
Max Meadows, VA 24360-3987

Mailing address

1123 Powder Mill Rd
Ivanhoe, VA 24350-3559
Phone (276) 699-0105

Other practice location 1

199 Hospital Dr
Suite 5
Galax, VA 24333-2454
Phone (276) 236-6136

Other identifiers 4

IdentifierTypeStateIssuer
10220815MedicaidVA
010220793MedicaidVA
010220807MedicaidVA
1068476OtherVANCCPA CERTIFICATE NUMBER

Other names 1

  • Ms. Brandi N Cannoy Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060130000253 VA Practitioner - Physician Assistant 7012921018 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0110-002204VAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wythe County Physician Practices LLC CurrentSince Dec 1, 2022 Accepting new patients
Wythe County Physician Practices LLC Family Medicine CurrentSince Dec 1, 2022 Accepting new patients
Ozarks Medical Center Family Medicine Past Accepting new patients
Wythe County Physician Practices LLC Past Accepting new patients
Wvva Health Care Alliance, PC Family Medicine Past Accepting new patients

Locations

600 W Ridge Rd
Wytheville, VA 24382
Phone (276) 228-0200

590 W Ridge Rd
Ste A
Wytheville, VA 24382
Phone (276) 228-7948

1155 N 4th St
Ste 502
Wytheville, VA 24382
Phone (276) 223-1334

Interoperability endpoints

  • Direct secure messaging: brandi.moore.1@19847.direct.athenahealth.com

Organizations & group practices 8

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.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Wythe County Physician Practices LLC 45 clinicians
Alliance Xpress Care LLC 16 clinicians

Practice addresses (Care Compare)

1155 N 4TH St
Suite 502
Wytheville, VA 24382-1097
Phone (276) 227-0375

5275 Alexander Rd
Suite a
Dublin, VA 24084-3657
Phone (540) 960-2231

590 W Ridge Rd
Wytheville, VA 24382-1067

600 W Ridge Rd
Wytheville, VA 24382-1044
Phone (276) 228-0200

919 S Craig Ave
Suite a
Covington, VA 24426-1954
Phone (540) 960-2231

Hospital & facility affiliations

  • Wythe County Community Hospital Hospital, Wytheville, VA, CCN 490111
  • Smyth County Community Hospital Hospital, Marion, VA, CCN 490038
  • Twin County Regional Hospital Hospital, Galax, VA, CCN 490115
  • Johnston Memorial Hospital Hospital, Abingdon, VA, CCN 490053
  • Lewisgale Hospital Pulaski Hospital, Pulaski, VA, CCN 490116

NPI Registry JSON

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

{
    "created_epoch": "1132876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641859200000",
    "number": "1528041381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1123 POWDER MILL RD",
            "city": "IVANHOE",
            "state": "VA",
            "postal_code": "243503559",
            "telephone_number": "276-699-0105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 FORT CHISWELL RD STE D",
            "city": "MAX MEADOWS",
            "state": "VA",
            "postal_code": "243603987",
            "telephone_number": "276-613-6991"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "199 Hospital Dr",
            "address_2": "Suite 5",
            "address_purpose": "LOCATION",
            "city": "Galax",
            "state": "VA",
            "postal_code": "243332454",
            "country_code": "US",
            "telephone_number": "276-236-6136",
            "fax_number": "276-236-2536",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "BRANDI",
        "middle_name": "N",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-25",
        "last_updated": "2022-01-11",
        "certification_date": "2022-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0110-002204",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110-002204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10220815",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010220793",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010220807",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA CERTIFICATE NUMBER",
            "identifier": "1068476",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRANDI",
            "last_name": "CANNOY",
            "middle_name": "N",
            "prefix": "MS.",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Max Meadows, VA

Sources for this page

Verify at the official NPI Registry.