Matthew Henry Moore, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1732 Issued in OK

Practice address

111 S Treaty Rd
Miami, OK 74354

Phone

(918) 540-1511

Fax

(918) 542-7374

NPI assigned

May 13, 2008

Last updated

Jan 7, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northeastern Tribal Health SystemGroup PAC ID 7911893854, 20 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Integris Miami Hospital Hospital, Miami, OK, CCN 370004

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Northeastern Tribal Health System

  • Clinic/Center
  • Miami, OK
  • NPI 1871522532

  TX

  Medicare reassignment Care Compare group
• Integris Baptist Regional Health Center

  dba Integris Baptist Regional Health Center ER Physician

  • Emergency Care Clinic/Center
  • Miami, OK
  • NPI 1811952963
  NPD (past)
• River Valley Urgent Care PA

  • Medical Specialty Clinic/Center
  • Fort Smith, AR
  • NPI 1619133394
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Integris Miami Hospital

  • General Acute Care Hospital
  • Miami, OK
  • NPI 1114931342
  Care Compare affiliation
• Integris Miami Hospital

  dba Integris Miami EMS

  • Ambulance
  • Miami, OK
  • NPI 1861534786

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1210636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546819200000",
    "number": "1700053394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 S TREATY RD",
            "city": "MIAMI",
            "state": "OK",
            "postal_code": "743545327",
            "telephone_number": "918-540-1511",
            "fax_number": "918-542-7374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S TREATY RD",
            "city": "MIAMI",
            "state": "OK",
            "postal_code": "74354",
            "telephone_number": "918-540-1511",
            "fax_number": "918-542-7374"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21 W Central Ave",
            "address_purpose": "LOCATION",
            "city": "Miami",
            "state": "OK",
            "postal_code": "743546815",
            "country_code": "US",
            "telephone_number": "918-542-3900",
            "fax_number": "918-542-3928",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MATTHEW",
        "middle_name": "HENRY",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-13",
        "last_updated": "2019-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "1732",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100736700O",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200207110A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Justin Mitchell, D.O.
• Lauren Alysse Mitchell, D.O.
• Modoc Nation Behavioral Health
• Sue Marie Montgomery, PT
• Mike Lee Moody, PTA
• Geneia Lynn Morgan, BS
• Rebecca J Morrissey, LCSW
• Amanda Jayne Morton, LMSW
• Channa Lee Morton, REGISTERED DIETICIAN
• Delisa Mowrey

• Physician Assistant in Miami, OK
• Providers in Miami, OK by specialty
• Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2019; 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.

Verify at the official NPI Registry.