NPIMap

Individual provider Active NPI

Lacey Floyd Moore Jr., M.D.

  • Diagnostic Radiology Physician
  • Pinehurst, NC
National Provider Identifier
1821071101
Registry record updated Aug 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
2008-00189 Issued in NC
Practice address
30 Memorial Dr
Pinehurst, NC 28374-8707
Phone
(910) 295-4400
NPI assigned
Nov 21, 2005
Last updated
Aug 30, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 2008-00189 NC Primary

Addresses

Primary practice location

30 Memorial Dr
Pinehurst, NC 28374-8707

Mailing address

30 Memorial Dr
Pinehurst, NC 28374-8707
Phone (910) 295-4400

Other identifiers 2

IdentifierTypeStateIssuer
5909323MedicaidNC
1821071101OtherBCBS NC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080710000407 NC Practitioner - Diagnostic Radiology 3375446875 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Emory University School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pinehurst Radiology Group P aGroup PAC ID 3678547536, 20 clinicians
First Imaging of the CarolinasGroup PAC ID 7315973948, 10 clinicians

Practice addresses (Care Compare)

106 Muirfield PL
Pinehurst, NC 28374-8958
Phone (910) 235-3994

155 Memorial Dr
Pinehurst, NC 28374-8710
Phone (910) 715-1000

30 Memorial Dr
Pinehurst, NC 28374-8707
Phone (910) 295-4400

355 S Bennett St
Southern Pines, NC 28387-5403
Phone (910) 295-4400

39 Lasswade Dr
Pinehurst, NC 28374-6703
Phone (910) 420-2932

46 Memorial Dr
Pinehurst, NC 28374-8707

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2008-00189NCMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
MCPC-27, LLC Diagnostic Radiology CurrentSince Feb 1, 2024 Accepting new patients
First Imaging of the Carolinas Diagnostic Radiology CurrentSince Nov 13, 2011 Accepting new patients
MCPC-19, LLC Diagnostic Radiology CurrentSince Dec 22, 2025 Accepting new patients
Pinehurst Radiology Group P a CurrentSince Jul 14, 2008 Accepting new patients
MCPC-19, LLC Diagnostic Radiology CurrentSince Sep 3, 2019 Accepting new patients

Locations

30 Memorial Dr
Pinehurst, NC 28374
Phone (910) 295-1831

Organizations & group practices 6

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1132531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314662400000",
    "number": "1821071101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 MEMORIAL DR",
            "city": "PINEHURST",
            "state": "NC",
            "postal_code": "283748707",
            "telephone_number": "910-295-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 MEMORIAL DR",
            "city": "PINEHURST",
            "state": "NC",
            "postal_code": "283748707",
            "telephone_number": "910-295-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "LACEY",
        "middle_name": "FLOYD",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-21",
        "last_updated": "2011-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "2008-00189",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5909323",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NC",
            "identifier": "1821071101",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pinehurst, NC

Sources for this page

Verify at the official NPI Registry.