Active NPI
Michael J Moore, MD
- Neurology Physician
- Concord, MA
National Provider Identifier
1689655151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 29410
- Practice address
- 131 Ornac
John Cummings BLDG
Concord, MA 01742-4181 - Phone
- (781) 259-0803
- NPI assigned
- Nov 10, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 29410 | MA | |
| Neurology Physician | 2084N0400X | 29410 | MA | Primary |
Addresses
Primary practice location
131 Ornac
John Cummings BLDG
Concord, MA 01742-4181
Mailing address
PO Box 9132
Brookline, MA 02446-9132
Phone (800) 927-0002
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| B23053 | Other | MA | BCBS |
| 029410 | Other | MA | TUFTS |
| 11461 | Other | MA | HARVARD PILGRIM |
| 000000024368 | Other | MA | BMC HEALTHNET |
| 3196640 | Medicaid | MA | |
| 05-04349 | Other | MA | UNITED HEALTHCARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250403000693 | MA | Order and Referring Only - Neurology | 7618998410 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29410 | MA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131580800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348704000000",
"number": "1689655151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9132",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024469132",
"telephone_number": "800-927-0002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "131 ORNAC",
"address_2": "JOHN CUMMINGS BLDG",
"city": "CONCORD",
"state": "MA",
"postal_code": "017424181",
"telephone_number": "781-259-0803"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "MICHAEL",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-10",
"last_updated": "2012-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "MA",
"license": "29410",
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "MA",
"license": "29410",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "B23053",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS",
"identifier": "029410",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM",
"identifier": "11461",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BMC HEALTHNET",
"identifier": "000000024368",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3196640",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "05-04349",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Concord, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2012; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.