Individual provider Active NPI

Mariah Janine Moore, SWT

  • Clinical Social Worker
  • Chardon, OH
National Provider Identifier
1598201659
Registry record updated Aug 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I.2103006 Issued in OH
Practice address
401 South St
4A
Chardon, OH 44024
Phone
(440) 285-2170
NPI assigned
Jan 13, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X I.2103006 OH Primary

Addresses

Primary practice location

401 South St
4A
Chardon, OH 44024

Mailing address

314 Irma Dr
Chardon, OH 44024-1424

Other identifiers 1

IdentifierTypeStateIssuer
S.1610524-TRNEMedicaidOH

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210827001626 OH Practitioner - Clinical Social Worker 4880099969 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ravenwood Mental Health CenterGroup PAC ID 6901813922, 57 clinicians

Practice addresses (Care Compare)

12557 Ravenwood Dr
Chardon, OH 44024-9009
Phone (440) 285-3568

Merit-based Incentive Payment System (MIPS)

Final score
91.68 of 100Reported as group
Quality
90.83
Improvement activities
40
Cost
72.41

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ravenwood Mental Health Center CurrentSince Aug 16, 2021 Accepting new patients
Ravenwood Mental Health Center CurrentSince Aug 16, 2021 Accepting new patients
Ravenwood Mental Health Center Current Accepting new patients

Locations

12557 Ravenwood Dr
Concord Twp, OH 44024
Phone (440) 990-6104

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/ravenwoodhealth/r4/

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1484265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629504000000",
    "number": "1598201659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 IRMA DR",
            "city": "CHARDON",
            "state": "OH",
            "postal_code": "440241424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 SOUTH ST",
            "address_2": "4A",
            "city": "CHARDON",
            "state": "OH",
            "postal_code": "44024",
            "telephone_number": "440-285-2170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MARIAH",
        "middle_name": "JANINE",
        "credential": "SWT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-01-13",
        "last_updated": "2021-08-21",
        "certification_date": "2021-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.2103006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "S.1610524-TRNE",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chardon, OH

Sources for this page

Verify at the official NPI Registry.