NPIMap

Individual provider Active NPI

Lane Ingram Moore, M.D.

  • Surgery Physician
  • Myrtle Beach, SC
National Provider Identifier
1598723900
Registry record updated Jul 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
22109 Issued in SC
Practice address
845 82ND Pkwy
Myrtle Beach, SC 29572-4614
Phone
(843) 449-9621
NPI assigned
May 3, 2006
Last updated
Jul 18, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 22109 SC Primary

Addresses

Primary practice location

845 82ND Pkwy
Myrtle Beach, SC 29572-4614

Mailing address

845 82ND Pkwy
Myrtle Beach, SC 29572-4614
Phone (843) 449-9621

Other identifiers 3

IdentifierTypeStateIssuer
221094MedicaidSC
89063Y4MedicaidNC
67728OtherMEDCOST

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070403000131 SC Practitioner - General SurgeryPractitioner - Vascular Surgery 5294638854 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General SurgeryAlso: Vascular Surgery
Education
Medical College of Georgia School of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Surgical Associates of Myrtle Beach, LLCGroup PAC ID 4587552179, 2 clinicians

Practice addresses (Care Compare)

210 Village Ctr Blvd
Suite 110
Myrtle Beach, SC 29579-6706
Phone (843) 449-9621

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.32 of 100Reported as individual
Quality
83.61
Improvement activities
40
Cost
99.59

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion84
Colonoscopy20
Hernia repair - groin (open)1-10
Mastectomy1-10
Laminectomy or laminotomy (partial removal of spine bones)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux11
Melanoma (skin cancer) excision19
Removal of tissue1-10
Removal of skin lesions37
Removal of nail tissue1-10
Skin biopsy15

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Surgical Associates of Myrtle Beach, LLC Surgery CurrentSince Aug 5, 2010 Accepting new patients
Tri-County Surgery, LLC Surgery Past Accepting new patients
Loris Surgical Associates, PA Surgery PastSince Jan 30, 2004 Accepting new patients

Locations

210 Village Center Blvd
Ste 110
Myrtle Beach, SC 29579
Phone (843) 449-8079

4036 River Oaks Dr
Unit B2
Myrtle Beach, SC 29579
Phone (757) 333-2066

845 82nd Pkwy
Myrtle Beach, SC 29572
Phone (843) 449-9621

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/ADBCDD

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.

Hospital & facility affiliations 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1310947200000",
    "number": "1598723900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 82ND PKWY",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724614",
            "telephone_number": "843-449-9621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 82ND PKWY",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724614",
            "telephone_number": "843-449-9621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "LANE",
        "middle_name": "INGRAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2011-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "SC",
            "license": "22109",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "221094",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89063Y4",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "67728",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

Verify at the official NPI Registry.