NPIMap

Individual provider Active NPI

Rhonda Moore, AGPCNP-BC

  • Gerontology Nurse Practitioner
  • Union, MS
National Provider Identifier
1669914826
Registry record updated Jun 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
R871925 Issued in MS
Practice address
24345 Highway 15
Union, MS 39365-8575
Phone
(601) 774-8211
Fax
(601) 774-8589
NPI assigned
Nov 4, 2016
Last updated
Jun 10, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X R871925 MS Primary

Addresses

Primary practice location

24345 Highway 15
Union, MS 39365-8575

Mailing address

24345 Highway 15
Union, MS 39365-8575
Phone (601) 747-8211

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170426000240 MS Practitioner - Nurse Practitioner 1254618481 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Laird Hospital, Inc.Group PAC ID 7214991769, 30 clinicians
Kemper Cah, Inc.Group PAC ID 5991985012, 28 clinicians

Practice addresses (Care Compare)

1106 Central Dr
Philadelphia, MS 39350-8972
Phone (601) 656-6921

24345 Hwy 15
Union, MS 39365-8575
Phone (601) 774-8211

4331 Hwy 39 N
Meridian, MS 39301-1007
Phone (601) 484-6180

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R871925MSMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Laird Hospital, Inc CurrentSince Feb 1, 2022 Accepting new patients
Kemper Cah, Inc CurrentSince Feb 1, 2022 Accepting new patients
Kemper Cah, Inc. Current Accepting new patients
Laird Hospital, Inc. CurrentSince Feb 1, 2022 Accepting new patients
Rush Medical Foundation Current Accepting new patients
Medical Foundation, Inc. CurrentSince Dec 18, 2023 Accepting new patients
Rush Medical Foundation CurrentSince Feb 1, 2022 Accepting new patients
Medical Foundation, Inc. CurrentSince Dec 18, 2023 Accepting new patients
Laird Hospital, Inc. Current Accepting new patients
Rush Medical Foundation CurrentSince Feb 1, 2022 Accepting new patients
Rush Medical Foundation Past Accepting new patients

Locations

9097 Collinsville Rd
Collinsville, MS 39325
Phone (601) 626-8874

14365 Highway 16 W
De Kalb, MS 39328
Phone (769) 486-1000

5334 Dale Dr
Marion, MS 39342
Phone (601) 703-0130

1314 19th Ave
Meridian, MS 39301
Phone (601) 483-0011

1500 Highway 19 N
Meridian, MS 39307
Phone (601) 483-5353

1710 14th St
Meridian, MS 39301
Phone (601) 703-1485

1800 12th St
Meridian, MS 39301
Phone (601) 483-0011

2401 16th St
Meridian, MS 39301
Phone (601) 482-4181

2800 N Hills St
Meridian, MS 39305
Phone (601) 693-9906

4331 Highway 39 N
Meridian, MS 39301
Phone (601) 482-5735

603 S Archusa Ave
Quitman, MS 39355
Phone (601) 776-2123

24345 Highway 15
Union, MS 39365
Phone (601) 774-8211

25117 Highway 15
Union, MS 39365
Phone (601) 774-8214

Organizations & group practices 11

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 4

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": "1478217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717977600000",
    "number": "1669914826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24345 HIGHWAY 15",
            "city": "UNION",
            "state": "MS",
            "postal_code": "393658575",
            "telephone_number": "601-747-8211",
            "fax_number": "601-774-8321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24345 HIGHWAY 15",
            "city": "UNION",
            "state": "MS",
            "postal_code": "393658575",
            "telephone_number": "601-774-8211",
            "fax_number": "601-774-8589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "RHONDA",
        "credential": "AGPCNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-04",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MS",
            "license": "R871925",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Union, MS

Sources for this page

Verify at the official NPI Registry.