Individual provider Active NPI

Bailie N Moore, APRN

  • Nurse Practitioner
  • Fayetteville, AR
National Provider Identifier
1619406949
Registry record updated Jun 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
112228 Issued in NE
Practice address
3232 N Northhills Blvd
Fayetteville, AR 72703-4005
Phone
(479) 587-1700
Fax
(479) 587-1366
NPI assigned
Jun 9, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 112228 NE Primary

Addresses

Primary practice location

3232 N Northhills Blvd
Fayetteville, AR 72703-4005

Mailing address

3232 N Northhills Blvd
Fayetteville, AR 72703-4005
Phone (479) 587-1700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200210001095 AR Practitioner - Nurse Practitioner 7012289937 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
112228NEMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Highlands Oncology Group PA CurrentSince Dec 14, 2019 Accepting new patients
Highlands Oncology Group, PA CurrentSince Dec 14, 2019 Accepting new patients

Locations

3232 N Northhills Blvd
Fayetteville, AR 72703
Phone (479) 695-1199

808 S 52nd St
Rogers, AR 72758
Phone (479) 878-1818

Interoperability endpoints

  • Direct secure messaging: bmoore50560@washingtonregional.direct-ci.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1496966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591315200000",
    "number": "1619406949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3232 N NORTHHILLS BLVD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034005",
            "telephone_number": "479-587-1700",
            "fax_number": "479-587-1366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3232 N NORTHHILLS BLVD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034005",
            "telephone_number": "479-587-1700",
            "fax_number": "479-587-1366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "BAILIE",
        "middle_name": "N",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-09",
        "last_updated": "2020-06-05",
        "certification_date": "2020-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NE",
            "license": "112228",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

Verify at the official NPI Registry.