Individual provider Active NPI

Richard A Moore, MD

  • Internal Medicine Physician
  • Belen, NM
National Provider Identifier
1689633935
Registry record updated Aug 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2002-0160 Issued in NM
Practice address
609 S Christopher Rd
PMG Belen
Belen, NM 87002
Phone
(505) 864-5454
Fax
(505) 864-5450
NPI assigned
Mar 23, 2006
Last updated
Aug 15, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2002-0160 NM Primary

Addresses

Primary practice location

609 S Christopher Rd
PMG Belen
Belen, NM 87002

Mailing address

PO Box 26666
PHS Provider Enrollment
Albuquerque, NM 87125-6666
Phone (505) 923-5356

Other identifiers 1

IdentifierTypeStateIssuer
K6868MedicaidNM

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050118000965 NM Practitioner - Internal Medicine 6507815420 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
27285AZMDInternal Medicine Physician
2002-0160NMMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Presbyterian Healthcare Services Internal Medicine CurrentSince Jul 1, 2006 Accepting new patients
Presbyterian Healthcare Services Internal Medicine CurrentSince Jul 1, 2006 Accepting new patients

Locations

609 Christopher Dr
Belen, NM 87002
Phone (505) 861-1771

2200 W 21st St
Clovis, NM 88101
Phone (505) 769-7577

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1218758400000",
    "number": "1689633935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26666",
            "address_2": "PHS PROVIDER ENROLLMENT",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871256666",
            "telephone_number": "505-923-5356",
            "fax_number": "505-923-5354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 S CHRISTOPHER RD",
            "address_2": "PMG BELEN",
            "city": "BELEN",
            "state": "NM",
            "postal_code": "87002",
            "telephone_number": "505-864-5454",
            "fax_number": "505-864-5450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "RICHARD",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-23",
        "last_updated": "2008-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NM",
            "license": "2002-0160",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "K6868",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Belen, NM

Sources for this page

Verify at the official NPI Registry.