Shannon Moore, DNP, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

470439451 Issued in MI

Practice address

3950 Beaubien St
Detroit, MI 48201-2166

Phone

(133) 832-9330

Fax

(313) 993-8685

NPI assigned

May 11, 2023

Sex

Female

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

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University PediatriciansGroup PAC ID 9638070568, 121 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Children'S Hospital of Michigan Hospital, Detroit, MI, CCN 233300

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• University Pediatricians

  • Pediatrics Physician
  • Detroit, MI
  • NPI 1811920549
  Medicare reassignment Care Compare group NPD
• University Pediatricians

  • Pediatrics Physician
  • Detroit, MI
  • NPI 1184471690
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• VHS Childrens Hospital of Michigan Inc

  • Children's Hospital
  • Detroit, MI
  • NPI 1538471800
  Care Compare affiliation

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

{
    "created_epoch": "1683763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713916800000",
    "number": "1811687916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3950 BEAUBIEN ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012166",
            "telephone_number": "133-832-9330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 BEAUBIEN ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012166",
            "telephone_number": "133-832-9330",
            "fax_number": "313-993-8685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "SHANNON",
        "name_prefix": "Dr.",
        "credential": "DNP, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-11",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "470439451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachelle Elizabeth Moore, MD
• Rebecca Ruth Moore
• Rosalyn Russell Moore, RN BSN
• Samella Moore
• Sarah Anna Moore, LMSW
• Sharee Lynette Moore, LPN
• Sharon Moore
• Shawn Moore
• Shelbie Mariah Moore
• Simone Devin Moore, MD

• Family Nurse Practitioner in Detroit, MI
• Providers in Detroit, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2024; 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.