NPIMap

Individual provider Active NPI

Stacia Adair Moore, AU.D.

  • Audiologist
  • Kalispell, MT
National Provider Identifier
1851394902
Registry record updated Oct 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
AU795 Issued in MT
Practice address
10 Three Mile Dr
Kalispell, MT 59901-3034
Phone
(406) 257-2273
Fax
(406) 257-7755
NPI assigned
May 23, 2005
Last updated
Oct 20, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X AU795 MT Primary

Addresses

Primary practice location

10 Three Mile Dr
Kalispell, MT 59901-3034

Mailing address

10 Three Mile Dr
Kalispell, MT 59901-3034
Phone (406) 257-2273

Other identifiers 3

IdentifierTypeStateIssuer
0561629MedicaidMT
290408OtherMTBLUE CROSS BLUE SHIELD
0533851MedicaidMT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
795MTMDClinical Social Worker
AU795MTMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Audiology Distribution, LLC PastSince Apr 17, 2018 Accepting new patients
Glacier Ear Nose and Throat Head and Neck Surgery PC PastSince Aug 28, 2006 Accepting new patients
Moore Hearing, PC Audiologist Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FGIEDD

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319068800000",
    "number": "1851394902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 THREE MILE DR",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599013034",
            "telephone_number": "406-257-2273",
            "fax_number": "406-257-7755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 THREE MILE DR",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599013034",
            "telephone_number": "406-257-2273",
            "fax_number": "406-257-7755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "STACIA",
        "middle_name": "ADAIR",
        "name_prefix": "Dr.",
        "credential": "AU.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-05-23",
        "last_updated": "2011-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "MT",
            "license": "AU795",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0561629",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "290408",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0533851",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalispell, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2011; 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.