Individual provider Active NPI

Patricia Moore, M.D.

  • Obstetrics & Gynecology Physician
  • Tyrone, GA
National Provider Identifier
1740204189
Registry record updated Sep 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
GA056875 Issued in GA
Practice address
190 Handley Rd
Tyrone, GA 30290-2178
Phone
(770) 997-5714
Fax
(770) 997-2810
NPI assigned
Jul 27, 2006
Last updated
Sep 2, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X GA056875 GA Primary

Addresses

Primary practice location

190 Handley Rd
Tyrone, GA 30290-2178

Mailing address

190 Handley Rd Ste a
Tyrone, GA 30290-2178
Phone (770) 997-5714

Other identifiers 2

IdentifierTypeStateIssuer
7966709OtherGAAETNA
741370127FMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20060119000189 GA Practitioner - Obstetrics/Gynecology 6800810755 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Johns Hopkins University School of Medicine, 2005
Medicare assignment
May accept Medicare assignment
Group practices
WMC Tyrone LLCGroup PAC ID 7113090705, 6 clinicians

Practice addresses (Care Compare)

190 Handley Rd
Suite a
Tyrone, GA 30290-2178
Phone (770) 997-5714

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.62 of 100Reported as apm
Quality
83.25
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
GA056875GAMDObstetrics & Gynecology Physician

Organizations & group practices 1

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599004800000",
    "number": "1740204189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 HANDLEY RD STE A",
            "city": "TYRONE",
            "state": "GA",
            "postal_code": "302902178",
            "telephone_number": "770-997-5714",
            "fax_number": "770-997-2810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 HANDLEY RD",
            "city": "TYRONE",
            "state": "GA",
            "postal_code": "302902178",
            "telephone_number": "770-997-5714",
            "fax_number": "770-997-2810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "PATRICIA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-27",
        "last_updated": "2020-09-02",
        "certification_date": "2020-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "GA056875",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7966709",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "741370127F",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyrone, GA

Sources for this page

Verify at the official NPI Registry.