Sam L. Moore III, M. ED

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

114 Ineichen St Ste a
Rayville, LA 71269-3223

Phone

(318) 417-7780

Fax

(318) 728-1140

NPI assigned

Nov 2, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

Practice roles

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.

• Total Wellness Advocates

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Rayville, LA
  • NPI 1942754064
  NPD (past)

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

{
    "created_epoch": "1541116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541116800000",
    "number": "1801364310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 OAK CIR",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712032722",
            "telephone_number": "318-557-9254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 INEICHEN ST STE A",
            "city": "RAYVILLE",
            "state": "LA",
            "postal_code": "712693223",
            "telephone_number": "318-417-7780",
            "fax_number": "318-728-1140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "SAM",
        "middle_name": "L.",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "M. ED",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-11-02",
        "last_updated": "2018-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Paul Middleton, OTR/L
• Catherine Miller
• Gwendolynn Minvielle
• Cynthia Montcalm, LPC-S, LMFT
• Ashley Moore
• Elnora Danielle Myles
• Roderick Myles I
• Charmetta Kay Nash
• Amanda Nicholson, LPN
• Northeast la. Substance Abuse Clinic

• Case Manager/Care Coordinator in Rayville, LA
• Providers in Rayville, LA by specialty
• Case Manager/Care Coordinator in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.