Active NPI
Jennifer Jane Moore, GC
- Genetic Counselor (M.S.)
- Indianapolis, IN
National Provider Identifier
1760910699
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Genetic Counselor (M.S.)
- License
- 74000181A
- Practice address
- 7120 Clearvista Dr Ste 5900
Indianapolis, IN 46256-1714 - Phone
- (317) 621-5395
- NPI assigned
- May 23, 2017
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Genetic Counselor (M.S.) | 170300000X | 74000181A | IN | Primary |
Addresses
Primary practice location
7120 Clearvista Dr Ste 5900
Indianapolis, IN 46256-1714
Mailing address
6626 E 75TH St Ste 500
Indianapolis, IN 46250-2890
Phone (317) 621-1647
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 300008014 | Medicaid | IN | |
| 74000181A | Other | IN | INDIANA GENETIC COUNSELOR LICENSE |
| K02-66-8390 | Other | KS | DRIVERS LICENSE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jmoore224097@eCommunityDirect.com | Community Physicians of Indiana Inc |
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 |
|---|---|---|---|
| 74000181A | IN | MD | Genetic Counselor (M.S.) |
Interoperability endpoints
- jmoore224097@ecommunitydirect.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1495497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1622764800000",
"number": "1760910699",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6626 E 75TH ST STE 500",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462502890",
"telephone_number": "317-621-1647"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7120 CLEARVISTA DR STE 5900",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462561714",
"telephone_number": "317-621-5395"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "JENNIFER",
"middle_name": "JANE",
"credential": "GC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-05-23",
"last_updated": "2021-06-04",
"certification_date": "2021-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "170300000X",
"taxonomy_group": "",
"desc": "Genetic Counselor, MS",
"state": "IN",
"license": "74000181A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "300008014",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDIANA GENETIC COUNSELOR LICENSE",
"identifier": "74000181A",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DRIVERS LICENSE",
"identifier": "K02-66-8390",
"state": "KS"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "jmoore224097@eCommunityDirect.com",
"affiliation": "Y",
"affiliationName": "Community Physicians of Indiana Inc",
"address_1": "7120 Clearvista Dr Ste 5900",
"city": "Indianapolis",
"state": "IN",
"country_code": "US",
"postal_code": "462561714",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.