Charlene K Moore, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9107673 Issued in FL

Practice address

160 NW Central Park PLZ Ste 103
Port St Lucie, FL 34986-1825

Phone

(772) 212-7636

Fax

(772) 212-7625

NPI assigned

Aug 13, 2008

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 names 1

• Ms. Charlene K Skubovius Former name

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Physician Assistant

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: cmoore@coralreefdermatology.emadirect.md

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.

• Coral Reef Dermatology LLC

  • Dermatology Physician
  • Port St Lucie, FL
  • NPI 1487300521
  Medicare reassignment Authorized official
• Selectskinmd LLC

  • MOHS-Micrographic Surgery Physician
  • Vero Beach, FL
  • NPI 1427414168
  Medicare reassignment

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

{
    "created_epoch": "1218585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671753600000",
    "number": "1639325376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 NW CENTRAL PARK PLZ STE 103",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349861825",
            "telephone_number": "772-212-7636",
            "fax_number": "772-212-7625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 NW CENTRAL PARK PLZ STE 103",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349861825",
            "telephone_number": "772-212-7636",
            "fax_number": "772-212-7625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "CHARLENE",
        "middle_name": "K",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-13",
        "last_updated": "2022-12-23",
        "certification_date": "2022-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50002517",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9107673",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHARLENE",
            "last_name": "SKUBOVIUS",
            "middle_name": "K",
            "prefix": "MS.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kristian Montgomery
• Kelsey Montoya
• Pierre Jacob Montrose, MD
• Nora Monval
• Jennifer Moody, ARNP
• Charles Moore
• Claudia Marlene Moore, OTA
• Jessica Moore
• Neldy Mor, RBT-25-430247
• Graziella G Mora, B.S., ATC, LAT

• Physician Assistant in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.