Active NPI
Charles Moore
- Speech-Language Pathologist
- Port St Lucie, FL
National Provider Identifier
1568911147
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SZ 7830
- Practice address
- 549 NW Lake Whitney PL Ste 103
Port St Lucie, FL 34986-1606 - Phone
- (772) 242-3187
- NPI assigned
- Sep 24, 2016
- 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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SZ 7830 | FL | Primary |
Addresses
Primary practice location
549 NW Lake Whitney PL Ste 103
Port St Lucie, FL 34986-1606
Mailing address
549 NW Lake Whitney PL Ste 103
Port St Lucie, FL 34986-1606
Phone (772) 242-3187
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SZ 7830 | FL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1474675200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1474675200000",
"number": "1568911147",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "549 NW LAKE WHITNEY PL STE 103",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349861606",
"telephone_number": "772-242-3187"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "549 NW LAKE WHITNEY PL STE 103",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349861606",
"telephone_number": "772-242-3187"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "CHARLES",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-09-24",
"last_updated": "2016-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "SZ 7830",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port St Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.