Tanisha Moore

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085-009934 Issued in IL

Practice address

311A Ridge Rd Apt 113
Wilmette, IL 60091-3256

Phone

(267) 505-6106

NPI assigned

Feb 20, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Cook County

  dba John H. Stroger, Jr. Hospital of Cook County

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1588612832
  Medicare reassignment
• Cook County

  dba Cook County Health & Hospitals System Physician Services

  • Emergency Medicine Physician
  • Chicago, IL
  • NPI 1821385170
  NPD
• Cook County

  dba Bronzeville Health Center

  • Multi-Specialty Clinic/Center
  • Chicago, IL
  • NPI 1831219450
  NPD
• Planned Parenthood of Illinois

  • Clinic/Center
  • Chicago, IL
  • NPI 1093121923
  NPD (past)
• Planned Parenthood of Illinois

  • Clinic/Center
  • Waukegan, IL
  • NPI 1285350694
  NPD (past)
• Planned Parenthood of Illinois

  • Clinic/Center
  • Chicago, IL
  • NPI 1790754745
  NPD (past)
• Planned Parenthood of Illinois

  • Clinic/Center
  • Aurora, IL
  • NPI 1831506773
  NPD (past)
• Planned Parenthood of Illinois

  • Clinic/Center
  • Chicago, IL
  • NPI 1841607785
  NPD (past)

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

{
    "created_epoch": "1676851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721692800000",
    "number": "1558069542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311A RIDGE RD APT 113",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600913256",
            "telephone_number": "267-505-6106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311A RIDGE RD APT 113",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600913256",
            "telephone_number": "267-505-6106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "TANISHA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-02-20",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-009934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shadan T Mohiuddin, RPH
• Nancy S Molitor, PHD
• Molly Schwartz, Inc
• Jeremy Montrose, DDS
• Megan Yoder Moore, DPT
• Carol Moran, MSW
• Charlee Morris
• Carol Solberg Moss, LCSW
• Shawn Mossell
• Movement Solutions LLC

• Physician Assistant in Wilmette, IL
• Providers in Wilmette, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.