NPIMap

Individual provider Active NPI

Fletcher Brady Moore, MD

  • Diagnostic Radiology Physician
  • Port Townsend, WA
National Provider Identifier
1851778674
Registry record updated Jul 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MD61681839 Issued in WA
Practice address
834 Sheridan St
Port Townsend, WA 98368-2443
Phone
(360) 385-2200
NPI assigned
Apr 30, 2015
Last updated
Jul 11, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 036-157557 IL
Diagnostic Radiology Physician 2085R0202X 27931 WV
Diagnostic Radiology Physician 2085R0202X D88788 MD
Diagnostic Radiology Physician 2085R0202X MD61681839 WA Primary

Addresses

Primary practice location

834 Sheridan St
Port Townsend, WA 98368-2443

Mailing address

111 Oakwood Rd
East Peoria, IL 61611-1853
Phone (309) 740-4272

Other practice location 1

530 NE Glen Oak Ave
Peoria, IL 61637-1544
Phone (309) 655-2000

Other identifiers 3

IdentifierTypeStateIssuer
2334210MedicaidWA
086220957MedicaidDC
184182300MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, WA, AK3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20211103002588 IL Practitioner - Diagnostic Radiology 4981982964
I20250725002995 WA Practitioner - Diagnostic Radiology 4981982964 Reassigns benefits to 8 organizations
I20250821001098 AK Practitioner - Diagnostic Radiology 4981982964 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of South Carolina School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairbanks Medical Imaging LLCGroup PAC ID 4082894407, 28 clinicians
Skagit Radiology Inc P SGroup PAC ID 7113815218, 39 clinicians
North Star Medical Imaging PLLCGroup PAC ID 7214005099, 30 clinicians
Skagit Digital Imaging LLCGroup PAC ID 4486543204, 29 clinicians
Bellingham Advanced Medical Imaging LLCGroup PAC ID 9739446824, 27 clinicians

Practice addresses (Care Compare)

101 N Main St
Coupeville, WA 98239-3413

1211 24TH St
Anacortes, WA 98221-2562
Phone (360) 424-6161

1320 E Division St
Mount Vernon, WA 98274-4133
Phone (360) 424-6161

1344 King St
Suite 101
Bellingham, WA 98229-6215
Phone (360) 424-6161

1415 E Kincaid St
Mount Vernon, WA 98274-4126
Phone (360) 424-6161

2310 Peger Rd
Suite 102
Fairbanks, AK 99709-5305
Phone (360) 424-6161

330 S Stillaguamish Ave
Arlington, WA 98223-1642
Phone (360) 424-6161

834 Sheridan St
Port Townsend, WA 98368-2443
Phone (360) 385-2200

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-157557ILMDDiagnostic Radiology Physician
D88788MDMDDiagnostic Radiology Physician
MD61681839WAMDDiagnostic Radiology Physician
27931WVMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Whidbey Island Public Hospital District Diagnostic Radiology CurrentSince Sep 2, 2025 Accepting new patients
North Star Medical Imaging PLLC Diagnostic Radiology CurrentSince Sep 2, 2025 Accepting new patients
Jefferson County Public Hospital District No 2 CurrentSince Aug 1, 2025 Accepting new patients
Whidbey Island Public Hospital District Diagnostic Radiology CurrentSince Sep 2, 2025 Accepting new patients
Whidbey Island Public Hospital District CurrentSince Sep 2, 2025 Accepting new patients
Fairbanks Medical Imaging LLC Diagnostic Radiology CurrentSince Sep 2, 2025 Accepting new patients
Whidbey Island Public Hospital District Current Accepting new patients
Bellingham Advanced Medical Imaging LLC Diagnostic Radiology CurrentSince Sep 2, 2025 Accepting new patients
Skagit Radiology Inc P S Diagnostic Radiology CurrentSince Sep 2, 2025 Accepting new patients

Locations

2310 Peger Rd
Ste 102
Fairbanks, AK 99709

250 Hospital Pl
Soldotna, AK 99669
Phone (907) 714-4404

1211 24th St
Anacortes, WA 98221
Phone (360) 293-3181

1344 King St
Ste 101
Bellingham, WA 98229
Phone (360) 676-6393

101 N Main St
Coupeville, WA 98239
Phone (360) 678-7656

125 N 18th St
Ste C
Mount Vernon, WA 98273
Phone (360) 428-7274

1320 E Division St
Mount Vernon, WA 98274
Phone (360) 424-9607

1415 E Kincaid St
Mount Vernon, WA 98274
Phone (360) 416-5750

1200 W Sims Way
Ste C
Port Townsend, WA 98368
Phone (360) 385-6297

834 Sheridan St
Port Townsend, WA 98368
Phone (360) 344-0400

934 Sheridan St
Port Townsend, WA 98368
Phone (360) 385-5330

Interoperability endpoints

  • Direct secure messaging: fletcher.moore@wh.jhie.net
  • Direct secure messaging: fmoore63373@skagit.direct-ci.com

Organizations & group practices 10

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 28

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

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1430352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752192000000",
    "number": "1851778674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 OAKWOOD RD",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "616111853",
            "telephone_number": "309-740-4272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "834 SHERIDAN ST",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983682443",
            "telephone_number": "360-385-2200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "530 NE Glen Oak Ave",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "IL",
            "postal_code": "616371544",
            "country_code": "US",
            "telephone_number": "309-655-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "FLETCHER",
        "middle_name": "BRADY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-30",
        "last_updated": "2025-07-11",
        "certification_date": "2025-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036-157557",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WV",
            "license": "27931",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MD",
            "license": "D88788",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WA",
            "license": "MD61681839",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2334210",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "086220957",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "184182300",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Townsend, WA

Sources for this page

Verify at the official NPI Registry.