Active NPI
Kelli Moore
- Physician Assistant
- Bingham Farms, MI
National Provider Identifier
1699243204
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601009656
- Practice address
- 32270 Telegraph Rd Ste 110
Bingham Farms, MI 48025-2456 - Phone
- (248) 792-9496
- NPI assigned
- Nov 13, 2018
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Physician Assistant | 363A00000X | 5601009656 | MI | Primary |
Addresses
Primary practice location
32270 Telegraph Rd Ste 110
Bingham Farms, MI 48025-2456
Mailing address
9103 Country View Dr
Ypsilanti, MI 48197-6650
Phone (502) 649-2954
Other practice location 1
9103 Country View Dr
Ypsilanti, MI 48197-6650
Phone (502) 649-2954
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2019
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
32270 Telegraph Rd
Suite 110
Bingham Farms, MI 48025-2456
5080 Spectrum Dr
Suite 1200W
Addison, TX 75001-6443
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1542067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597536000000",
"number": "1699243204",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9103 COUNTRY VIEW DR",
"city": "YPSILANTI",
"state": "MI",
"postal_code": "481976650",
"telephone_number": "502-649-2954"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "32270 TELEGRAPH RD STE 110",
"city": "BINGHAM FARMS",
"state": "MI",
"postal_code": "480252456",
"telephone_number": "248-792-9496"
}
],
"practiceLocations": [
{
"address_1": "9103 Country View Dr",
"address_purpose": "LOCATION",
"city": "Ypsilanti",
"state": "MI",
"postal_code": "481976650",
"country_code": "US",
"telephone_number": "502-649-2954",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MOORE",
"first_name": "KELLI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-11-13",
"last_updated": "2020-08-16",
"certification_date": "2020-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601009656",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bingham Farms, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2020; 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.