NPIMap

Organization Active NPI

Moore Medical Group Inc

  • Family Medicine Physician
  • Lake Mary, FL
National Provider Identifier
1578724183
Registry record updated Oct 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME63176 Issued in FL
Legal business name
MOORE MEDICAL GROUP INC
Practice address
4300 W Lake Mary Blvd
Ste 1010-357
Lake Mary, FL 32746-2060
Phone
(407) 732-7957
Fax
(407) 732-7925
NPI assigned
Jun 17, 2008
Last updated
Oct 9, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2023

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

Authorized official

Name
Eric Alan Moore, M.D.
Title
Physician
Phone
(407) 732-7957

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME63176 FL Primary

Addresses

Primary practice location

4300 W Lake Mary Blvd
Ste 1010-357
Lake Mary, FL 32746-2060

Mailing address

4300 W Lake Mary Blvd
Ste 1010-357
Lake Mary, FL 32746-2060
Phone (407) 732-7957

Other identifiers 1

IdentifierTypeStateIssuer
006387600MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140714002086 NC Part B Supplier - Clinic/Group Practice 9638354889 Receives reassigned benefits from 19 practitioners
Practice locations: Garner, NC; Leland, NC
O20220808000910 TN Part B Supplier - Clinic/Group Practice 9638354889 Receives reassigned benefits from 1 practitioner
Practice locations: Nashville, TN

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

1355 S International Pkwy
Ste 1481
Lake Mary, FL 32746
Phone (407) 323-1234

4300 W Lake Mary Blvd
Ste 1010357
Lake Mary, FL 32746

880 Dr Martin Luther King Jr Blvd
Melbourne, FL 32901
Phone (321) 722-0630

722 E Butler Pike
Maple Glen, PA 19002
Phone (215) 643-7800

561 Fairthorne Ave
Philadelphia, PA 19128
Phone (215) 487-4000

7000 US 287 Hwy
#A
Arlington, TX 76001
Phone (817) 662-6342

Practitioners & affiliated clinicians

Practitioners 39

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1213660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696809600000",
    "number": "1578724183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 W LAKE MARY BLVD",
            "address_2": "STE 1010-357",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327462060",
            "telephone_number": "407-732-7957",
            "fax_number": "407-732-7925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 W LAKE MARY BLVD",
            "address_2": "STE 1010-357",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327462060",
            "telephone_number": "407-732-7957",
            "fax_number": "407-732-7925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOORE MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-17",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "407-732-7957",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME63176",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006387600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Mary, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.