NPIMap

Individual provider Active NPI

Sandra J. Moore, NP

  • Family Nurse Practitioner
  • Pine City, MN
National Provider Identifier
1851510366
Registry record updated Nov 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R 181983-4 Issued in MN
Practice address
1425 Main St N
Pine City, MN 55063-6026
Phone
(320) 629-7505
Fax
(320) 629-2202
NPI assigned
Apr 24, 2007
Last updated
Nov 12, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 157868 WI
Family Nurse Practitioner 363LF0000X R 181983-4 MN Primary

Addresses

Primary practice location

1425 Main St N
Pine City, MN 55063-6026

Mailing address

1425 Main St N
Pine City, MN 55063-6026
Phone (320) 629-7505

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address smoore70000@excellian.direct.allina.com Direct Welia Health

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20080722000007 MN Practitioner - Nurse Practitioner 5991803082 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Cincinnati College of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Welia HealthGroup PAC ID 6709295496, 60 clinicians

Practice addresses (Care Compare)

1425 Main St N
Pine City, MN 55063-6026
Phone (320) 629-7505

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1755MNMDClinical Social Worker
157868WIMDNurse Practitioner
R 181983-4MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Welia Health Current Accepting new patients
Welia Health CurrentSince Mar 24, 2022 Accepting new patients

Locations

301 Highway 65 S
Mora, MN 55051
Phone (320) 225-3317

1425 Main St N
Pine City, MN 55063
Phone (320) 322-5141

Interoperability endpoints

  • Direct secure messaging: smoore70000@excellian.direct.allina.com

Organizations & group practices 2

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 34

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

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605139200000",
    "number": "1851510366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 MAIN ST N",
            "city": "PINE CITY",
            "state": "MN",
            "postal_code": "550636026",
            "telephone_number": "320-629-7505",
            "fax_number": "320-629-2202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 MAIN ST N",
            "city": "PINE CITY",
            "state": "MN",
            "postal_code": "550636026",
            "telephone_number": "320-629-7505",
            "fax_number": "320-629-2202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "SANDRA",
        "middle_name": "J.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-24",
        "last_updated": "2020-11-12",
        "certification_date": "2020-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "157868",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "R 181983-4",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "smoore70000@excellian.direct.allina.com",
            "affiliation": "Y",
            "affiliationName": "Welia Health",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "1425 Main Street North",
            "city": "Pine City",
            "state": "MN",
            "country_code": "US",
            "postal_code": "550631530",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pine City, MN

Sources for this page

Verify at the official NPI Registry.