Active NPI
Jeremy Moore
- Clinical Social Worker
- Durham, NC
National Provider Identifier
1528419736
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- C010415
- Practice address
- 2009 Chapel Hill Rd
Durham, NC 27707-1109 - Phone
- (919) 276-4255
- NPI assigned
- Jun 29, 2016
- Last updated
- Jan 4, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | C010415 | NC | Primary |
Addresses
Primary practice location
2009 Chapel Hill Rd
Durham, NC 27707-1109
Mailing address
2009 Chapel Hill Rd
Durham, NC 27707-1109
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 17, 2024 through Jun 17, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C010415 | NC | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1467158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704326400000",
"number": "1528419736",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2009 CHAPEL HILL RD",
"city": "DURHAM",
"state": "NC",
"postal_code": "277071109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2009 CHAPEL HILL RD",
"city": "DURHAM",
"state": "NC",
"postal_code": "277071109",
"telephone_number": "919-276-4255"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "JEREMY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-06-29",
"last_updated": "2024-01-04",
"certification_date": "2024-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "C010415",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Durham, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.