Active NPI
Matthew Ryan Moore, M.D.
- Family Medicine Physician
- Casper, WY
National Provider Identifier
1780912246
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 8369A
- Practice address
- 6500 E 2ND St
Suite 200
Casper, WY 82609-4338 - Phone
- (307) 577-5100
- NPI assigned
- Nov 20, 2009
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 8369A | WY | Primary |
Addresses
Primary practice location
6500 E 2ND St
Suite 200
Casper, WY 82609-4338
Mailing address
416 S Lincoln St
Casper, WY 82601-3236
Phone (512) 321-8664
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780912246 | Other | BC/BS |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8369A | WY | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Glenrock Hospital District | Past | Accepting new patients | |
| Oregon Trail Emergency Physicians LLC | Past | Accepting new patients |
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.
-
- Clinical Medical Laboratory
- Glenrock, WY
- NPI 1437294972
-
- Emergency Medicine Physician
- Casper, WY
- NPI 1518125384
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1258675200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285545600000",
"number": "1780912246",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "416 S LINCOLN ST",
"city": "CASPER",
"state": "WY",
"postal_code": "826013236",
"telephone_number": "512-321-8664"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6500 E 2ND ST",
"address_2": "SUITE 200",
"city": "CASPER",
"state": "WY",
"postal_code": "826094338",
"telephone_number": "307-577-5100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "MATTHEW",
"middle_name": "RYAN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-11-20",
"last_updated": "2010-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WY",
"license": "8369A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "1780912246",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Casper, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.