Individual provider Active NPI

Edward Ryan Moore, RN, CRNP

  • Family Nurse Practitioner
  • Montgomery, AL
National Provider Identifier
1700476405
Registry record updated Oct 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1-163024 Issued in AL
Practice address
454 Taylor Rd
Montgomery, AL 36117-3563
Phone
(334) 613-9000
Fax
(334) 532-0056
NPI assigned
Jan 26, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 1-163024 AL
Family Nurse Practitioner 363LF0000X 1-163024 AL Primary

Addresses

Primary practice location

454 Taylor Rd
Montgomery, AL 36117-3563

Mailing address

454 Saddlewood Dr
Pike Road, AL 36064-2736
Phone (334) 315-4813

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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

Enrollment IDStateProvider typePAC IDDetails
I20211207002154 AL Practitioner - Nurse Practitioner 7810387743 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
American Family Care, LLCGroup PAC ID 9739087818, 180 clinicians

Practice addresses (Care Compare)

2570 Berryhill Rd
Montgomery, AL 36117-3564
Phone (334) 323-1330

Merit-based Incentive Payment System (MIPS)

Final score
70.43 of 100Reported as group
Quality
65.59
Improvement activities
40
Cost
64.54

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse, Registered Nurse

State licenses

LicenseStateTypeSpecialty
1-163024ALMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
American Family Care, LLC CurrentSince Feb 3, 2022 Accepting new patients
American Family Care, LLC CurrentSince Feb 3, 2022 Accepting new patients

Locations

120 Colonial Promenade Pkwy
Alabaster, AL 35007
Phone (205) 605-0495

3700 Cahaba Beach Rd
Hoover, AL 35242
Phone (205) 403-8902

8151 Whitesburg Dr SE
Huntsville, AL 35802
Phone (256) 882-9711

2570 Berryhill Rd
Montgomery, AL 36117
Phone (334) 323-1330

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1611619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635379200000",
    "number": "1700476405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "454 SADDLEWOOD DR",
            "city": "PIKE ROAD",
            "state": "AL",
            "postal_code": "360642736",
            "telephone_number": "334-315-4813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "454 TAYLOR RD",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361173563",
            "telephone_number": "334-613-9000",
            "fax_number": "334-532-0056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "EDWARD",
        "middle_name": "RYAN",
        "credential": "RN, CRNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-01-26",
        "last_updated": "2021-10-28",
        "certification_date": "2021-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AL",
            "license": "1-163024",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-163024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montgomery, AL

Sources for this page

Verify at the official NPI Registry.