Colleen Johnson Moore, M.D.

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

036113689 Issued in IL

Practice address

21 Doctors Park Ste a
Cape Girardeau, MO 63703-4927

Phone

(217) 788-0706

Fax

(217) 525-2535

NPI assigned

Nov 7, 2005

Sex

Female

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 2

Other names 1

• Coleen M Johnson Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL, MO2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Vascular SurgeryAlso: General Surgery

Education

University of Missouri, Kansas City, School of Medicine, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Invein LLC

  • Vascular Surgery Physician
  • Cape Girardeau, MO
  • NPI 1467132951
  Medicare reassignment NPD Authorized official
• St Anthonys Memorial Hospital of the Hospital Sisters of the Third

  dba St. Anthony's Memorial Hospital

  • General Acute Care Hospital
  • Effingham, IL
  • NPI 1306800602
  Medicare reassignment NPD
• HSHS Medical Group Inc

  • Rural Health Clinic/Center
  • Rushville, IL
  • NPI 1487719480
  NPD (past)
• Prairie Cardiovascular Consultants LTD

  • Cardiovascular Disease Physician
  • Springfield, IL
  • NPI 1659539559
  NPD (past)

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

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690416000000",
    "number": "1801877923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 DOCTORS PARK STE A",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637034927",
            "telephone_number": "573-837-4131",
            "fax_number": "573-837-4132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 DOCTORS PARK STE A",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637034927",
            "telephone_number": "217-788-0706",
            "fax_number": "217-525-2535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "COLLEEN",
        "middle_name": "JOHNSON",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-07",
        "last_updated": "2023-07-27",
        "certification_date": "2023-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MO",
            "license": "2004001641",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "IL",
            "license": "036113689",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036113689",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "F400526418",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cmoore229890@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "619 E Mason St Ste 4P57",
            "city": "Springfield",
            "state": "IL",
            "country_code": "US",
            "postal_code": "627011034",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "COLEEN",
            "last_name": "JOHNSON",
            "middle_name": "M",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Emily Clare Montgomery
• Jazzmine Madison Moody
• Charles M. Moon, MD
• Andrew Jacob Moore, M.D.
• Brianna Claire Moore
• Dana Marie Moore, APRN
• Donnellya Moore
• Grace Kathleen Moore, MA, NCC
• Jerri Denise Moore, MA, LPC
• Kimyatta Moore

• Vascular Surgery Physician in Cape Girardeau, MO
• Providers in Cape Girardeau, MO by specialty
• Vascular Surgery Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.