Active NPI
Jason Wayne Moore, LAT/ATC
- Athletic Trainer
- Jackson, MO
National Provider Identifier
1740511716
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2009029675
- Practice address
- 315 S Missouri St
Jackson, MO 63755-2000 - Phone
- (573) 837-5960
- NPI assigned
- Jan 14, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2009029675 | MO | Primary |
Addresses
Primary practice location
315 S Missouri St
Jackson, MO 63755-2000
Mailing address
175 Mark Ave
Jackson, MO 63755-8437
Phone (573) 837-5960
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2009029675 | MO | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mid America Rehab, P.C. | Athletic Trainer | Past | Accepting new patients |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1263427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725580800000",
"number": "1740511716",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "175 MARK AVE",
"city": "JACKSON",
"state": "MO",
"postal_code": "637558437",
"telephone_number": "573-837-5960"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "315 S MISSOURI ST",
"city": "JACKSON",
"state": "MO",
"postal_code": "637552000",
"telephone_number": "573-837-5960"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "JASON",
"middle_name": "WAYNE",
"credential": "LAT/ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-01-14",
"last_updated": "2024-09-06",
"certification_date": "2024-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MO",
"license": "2009029675",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.