Ivonne Moore III, BA

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

484 Main St
Suite 450
Worcester, MA 01608-1893

Phone

(508) 752-2590

Fax

(508) 753-5051

NPI assigned

Jul 21, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts

Practice roles

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

• Spectrum Health Systems Inc

  • Multi-Specialty Clinic/Center
  • Worcester, MA
  • NPI 1376827188
  NPD (past)
• Spectrum Health Systems, Inc

  • Addiction (Substance Use Disorder) Counselor
  • Worcester, MA
  • NPI 1487608485
  NPD (past)

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

{
    "created_epoch": "1311206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311206400000",
    "number": "1619265832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 MERRICK ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016091937",
            "telephone_number": "508-797-6100",
            "fax_number": "508-797-0693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "484 MAIN ST",
            "address_2": "SUITE 450",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016081893",
            "telephone_number": "508-752-2590",
            "fax_number": "508-753-5051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "IVONNE",
        "name_suffix": "III",
        "credential": "BA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-21",
        "last_updated": "2011-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1308785",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "22220002001",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306461",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "M18684",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiffany A. Moore-Simas, M.D.
• Brooke Moore
• Caisse Lee Moore
• Griffin Moore
• Hannah Stapleton Moore, NP
• Jessica Noelle Moore
• Julie Moore
• Kara Moore
• Keely Elizabeth Moore, MS, CCC-SLP
• Kelsey Lynn Moore, NP

• Addiction (Substance Use Disorder) Counselor in Worcester, MA
• Providers in Worcester, MA by specialty
• Addiction (Substance Use Disorder) Counselor in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.