Individual provider Active NPI

Timothy J Moore, CRNA

  • Certified Registered Nurse Anesthetist
  • Collierville, TN
National Provider Identifier
1609575695
Registry record updated Jun 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
36528 Issued in TN
Practice address
1152 Greenview Rd
Collierville, TN 38017-1160
Phone
(901) 674-4636
NPI assigned
Feb 28, 2023
Last updated
Jun 30, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 36528 TN Primary
Certified Registered Nurse Anesthetist 367500000X 901929 MS

Addresses

Primary practice location

1152 Greenview Rd
Collierville, TN 38017-1160

Mailing address

1152 Greenview Rd
Collierville, TN 38017-1160
Phone (901) 674-4636

Other identifiers 1

IdentifierTypeStateIssuer
Q094735MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240816000085 TN Practitioner - Certified Registered Nurse Anesthetist (Crna) 7416495890 Reassigns benefits to 2 organizations
I20240830001752 MS Practitioner - Certified Registered Nurse Anesthetist (Crna) 7416495890 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Resource Anesthesiology Associates of TN PCGroup PAC ID 8527419092, 145 clinicians

Practice addresses (Care Compare)

4250 Bethel Rd
Olive Branch, MS 38654-8737
Phone (662) 932-9000

7691 Poplar Ave
Germantown, TN 38138-3904
Phone (901) 516-6000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Resource Anesthesiology Associates of TN PC Nurse Anesthetist, Certified Registered CurrentSince Apr 2, 2025 Accepting new patients
Gastroenterology Center of the Midsouth PLLC Nurse Anesthetist, Certified Registered CurrentSince Jul 30, 2024 Accepting new patients
G I Diagnostic and Therapeutic Center LLC Current Accepting new patients
Specialty Physician Group LLC Past Accepting new patients

Locations

4250 Bethel Rd
Olive Branch, MS 38654
Phone (662) 932-9000

7668 Airways Blvd
Bldg 2
Southaven, MS 38671
Phone (901) 766-9490

7900 Airways Blvd
Bldg B100
Southaven, MS 38671
Phone (662) 349-2442

7900 Airways Blvd
Ste 101
Southaven, MS 38671
Phone (662) 349-6950

589 Garfield St
Ste 201
Tupelo, MS 38801
Phone (662) 680-5565

450 Mamaroneck Ave
Ste 201
Harrison, NY 10528
Phone (877) 476-6642

Gastro Onegovt Arhcl
New York, NY 10087

65 Germantown Ct
Ste 300
Cordova, TN 38018

1310 Wolf Park Dr
Germantown, TN 38138
Phone (901) 624-5151

1265 Union Ave
Memphis, TN 38104
Phone (901) 516-2362

1265 Union Ave
Ste 201
Memphis, TN 38104
Phone (901) 516-7000

1300 Wesley Dr
Memphis, TN 38116
Phone (901) 516-3700

1325 Eastmoreland Ave
Ste 410
Memphis, TN 38104
Phone (901) 261-6650

3960 New Covington Pike
Memphis, TN 38128
Phone (901) 516-5200

7691 Poplar Ave
Memphis, TN 38138
Phone (901) 516-1290

8000 Wolf River Blvd
Ste 200
Memphis, TN 38138
Phone (901) 684-5503

Organizations & group practices 4

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 3

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

NPI Registry JSON

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

{
    "created_epoch": "1677542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782777600000",
    "number": "1609575695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1152 GREENVIEW RD",
            "city": "COLLIERVILLE",
            "state": "TN",
            "postal_code": "380171160",
            "telephone_number": "901-674-4636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1152 GREENVIEW RD",
            "city": "COLLIERVILLE",
            "state": "TN",
            "postal_code": "380171160",
            "telephone_number": "901-674-4636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "TIMOTHY",
        "middle_name": "J",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-02-28",
        "last_updated": "2026-06-30",
        "certification_date": "2026-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "36528",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MS",
            "license": "901929",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q094735",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Collierville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.