Active NPI
Wilesha Shanise Moore, PA-C
- Physician Assistant
- Greenville, SC
National Provider Identifier
1659136240
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 6106
- Practice address
- 545 W Butler Rd
Greenville, SC 29607-4833 - Phone
- (864) 299-1990
- Fax
- (864) 299-9123
- NPI assigned
- Feb 14, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 6106 | SC | Primary |
Addresses
Primary practice location
545 W Butler Rd
Greenville, SC 29607-4833
Mailing address
545 W Butler Rd
Greenville, SC 29607-4833
Phone (864) 299-1990
Other practice location 1
2555 N Pleasantburg Dr
Greenville, SC 29609-3030
Phone (864) 609-4008
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
4055 Valley View LN
Suite 400
Dallas, TX 75244-4910
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Organizations & group practices 1
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": "1707868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1784937600000",
"number": "1659136240",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "545 W BUTLER RD",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296074833",
"telephone_number": "864-299-1990",
"fax_number": "864-299-9123"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "545 W BUTLER RD",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296074833",
"telephone_number": "864-299-1990",
"fax_number": "864-299-9123"
}
],
"practiceLocations": [
{
"address_1": "2555 N Pleasantburg Dr",
"address_purpose": "LOCATION",
"city": "Greenville",
"state": "SC",
"postal_code": "296093030",
"country_code": "US",
"telephone_number": "864-609-4008",
"fax_number": "864-299-9123",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MOORE",
"first_name": "WILESHA",
"middle_name": "SHANISE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-02-14",
"last_updated": "2026-07-25",
"certification_date": "2026-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "SC",
"license": "6106",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2026; 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.