Active NPI
Jerry R Moore, LPC, LICDC
- Professional Counselor
- Marysville, OH
National Provider Identifier
1558845743
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- E.1901574-SUPV
- Practice address
- 16000 Hunters Run
Marysville, OH 43040-9659 - Phone
- (614) 582-1081
- NPI assigned
- Sep 24, 2018
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | E.1901574-SUPV | OH | Primary |
Addresses
Primary practice location
16000 Hunters Run
Marysville, OH 43040-9659
Mailing address
16000 Hunters Run
Marysville, OH 43040-9659
Phone (614) 582-1081
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
4995 Bradenton Ave
Suite 130
Dublin, OH 43017-3551
Phone (614) 580-6917
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E.1901574-SUPV | OH | MD | Professional Counselor |
Organizations & group practices 2
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.
-
- Family Medicine Physician
- Columbus, OH
- NPI 1497482111
-
- Multi-Specialty Clinic/Center
- Hilliard, OH
- NPI 1942910252
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1537747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1775606400000",
"number": "1558845743",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16000 HUNTERS RUN",
"city": "MARYSVILLE",
"state": "OH",
"postal_code": "430409659",
"telephone_number": "614-582-1081"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16000 HUNTERS RUN",
"city": "MARYSVILLE",
"state": "OH",
"postal_code": "430409659",
"telephone_number": "614-582-1081"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "JERRY",
"middle_name": "R",
"credential": "LPC, LICDC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-09-24",
"last_updated": "2026-04-08",
"certification_date": "2026-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OH",
"license": "E.1901574-SUPV",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marysville, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2026; 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.