Jeffery W Moore, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

28087122A Issued in IN

Practice address

1000 S Main St
Tipton, IN 46072-9753

Phone

(765) 675-8521

Fax

(765) 675-8520

NPI assigned

Dec 6, 2005

Last updated

Oct 1, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

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.

• Four County Comprehensive Mental Health Center, Inc

  dba 4C Health

  • Psychiatric Hospital
  • Peru, IN
  • NPI 1457539751
  NPD (past)

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

{
    "created_epoch": "1133827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412121600000",
    "number": "1801870480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 S MAIN ST",
            "city": "TIPTON",
            "state": "IN",
            "postal_code": "460729753",
            "telephone_number": "765-675-8521",
            "fax_number": "765-675-8520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 S MAIN ST",
            "city": "TIPTON",
            "state": "IN",
            "postal_code": "460729753",
            "telephone_number": "765-675-8521",
            "fax_number": "765-675-8520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "JEFFERY",
        "middle_name": "W",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-06",
        "last_updated": "2014-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IN",
            "license": "28087122A",
            "primary": true
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "IN",
            "license": "28087122",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200345230A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200345230",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM - TIPTON HOSPITAL",
            "identifier": "000000603596",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julie Ann Miller, MSW LCSW
• Rachel Miller, PTA
• Miller's Health Systems, Inc. (Miller's Merry Manor)
• Ravi K Misra, MD
• Mobile Helath Services of Indiana (Innovative Pain Therapies)
• Northern Surgical Consultants, P.C.
• Oasis Recovery, LLC
• Shelby Ann Patterson, LCSW
• Beth Suzanne Phalen, P.T.
• Tracey Powell, D.C.

• Certified Registered Nurse Anesthetist in Tipton, IN
• Providers in Tipton, IN by specialty
• Certified Registered Nurse Anesthetist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2014; 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.