NPIMap

Individual provider Active NPI

Mark Owen Moore, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Boise, ID
National Provider Identifier
1821261918
Registry record updated Aug 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
M-12018 Issued in ID
Practice address
999 N Curtis Rd
Suite 117
Boise, ID 83706-1336
Phone
(208) 367-2155
NPI assigned
Apr 9, 2008
Last updated
Aug 19, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X M-12018 ID Primary

Addresses

Primary practice location

999 N Curtis Rd
Suite 117
Boise, ID 83706-1336

Mailing address

990 E Winding Creek Dr
Eagle, ID 83616-7231
Phone (303) 587-7090

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20130924000575 ID Practitioner - Pathology 0143464651 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
University of Washington School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1055 N Curtis Rd
Boise, ID 83706-1309
Phone (208) 367-2121

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St Alphonsus Professional Medical Services LLC CurrentSince Jul 24, 2013 Accepting new patients
St Alphonsus Professional Medical Services LLC Anatomic Pathology & Clinical Pathology CurrentSince Jul 24, 2013 Accepting new patients
Saint Alphonsus Regional Medical Center Inc Anatomic Pathology & Clinical Pathology CurrentSince Feb 26, 2022 Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Feb 26, 2022 Accepting new patients

Locations

1055 N Curtis Rd
Boise, ID 83706
Phone (208) 367-2152

999 N Curtis Rd
Ste 117
Boise, ID 83706
Phone (208) 367-2153

3340 E Goldstone Dr
Meridian, ID 83642
Phone (208) 302-9342

Organizations & group practices 4

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 9

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": "1207699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376870400000",
    "number": "1821261918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "990 E WINDING CREEK DR",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836167231",
            "telephone_number": "303-587-7090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "999 N CURTIS RD",
            "address_2": "SUITE 117",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061336",
            "telephone_number": "208-367-2155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MARK",
        "middle_name": "OWEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-09",
        "last_updated": "2013-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "ID",
            "license": "M-12018",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.