Individual provider Active NPI

Jeffrey Robert Moore, M.D.

  • Pediatric Cardiology Physician
  • Columbus, OH
National Provider Identifier
1861719213
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
35.122535 Issued in OH
Practice address
700 Childrens Dr
Columbus, OH 43205-2664
Phone
(614) 722-4384
NPI assigned
Apr 26, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 35.122535 OH
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X 35122535 OH
Pediatric Cardiology Physician 2080P0202X 35.122535 OH Primary

Addresses

Primary practice location

700 Childrens Dr
Columbus, OH 43205-2664

Mailing address

700 Childrens Dr
Columbus, OH 43205-2664
Phone (614) 722-4384

Other practice location 1

1400 E 2nd St
Defiance, OH 43512-9905
Phone (419) 251-8035

Other practice location 2

500 W Market St
Tiffin, OH 44883-2610
Phone (419) 251-8035

Other practice location 3

730 W. High Street
Lima, OH 45801
Phone (419) 251-8035

Other practice location 4

2222 Cherry St Ste 2800
Toledo, OH 43608-2675
Phone (419) 251-8035

Other practice location 5

2213 Cherry St
Toledo, OH 43608-2603
Phone (419) 251-8035

Other identifiers 1

IdentifierTypeStateIssuer
0127102MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jmoore56793@epicdirect.promedica.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160726002583 OH Practitioner - Pediatric Medicine 7719289677 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Wright State University Boonshoft School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Promedica Children'S SpecialistsGroup PAC ID 6709975345, 16 clinicians

Practice addresses (Care Compare)

2121 Hughes Dr
Toledo, OH 43606-3857

Hospital & facility affiliations

  • Promedica Toledo Hospital Hospital, Toledo, OH, CCN 360068

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.122535OHMDPediatric Cardiology Physician
35122535OHMDPediatric Emergency Medicine (Pediatrics) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Pediatric Specialists, LLC Pediatrics CurrentSince Mar 17, 2023 Accepting new patients
Promedica Children'S Specialists Pediatrics CurrentSince Aug 1, 2016 Accepting new patients
The Toledo Hospital Pediatrics CurrentSince Dec 1, 2018 Accepting new patients
The Toledo Hospital CurrentSince Dec 1, 2018 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

700 Childrens Dr
Columbus, OH 43205
Phone (614) 722-4411

1400 E 2nd St
Defiance, OH 43512
Phone (419) 784-1414

3521 Briarfield Blvd
Maumee, OH 43537
Phone (419) 794-7259

500 W Market St
Tiffin, OH 44883
Phone (419) 251-8210

1 Seagate
#800
Toledo, OH 43604
Phone (567) 585-1964

2142 N Cove Blvd
Toledo, OH 43606
Phone (419) 291-1111

2121 Hughes Dr
Ste 750
Toledo, OH 43606
Phone (419) 291-7800

2213 Cherry St
Toledo, OH 43608
Phone (419) 251-4283

2222 Cherry St
Toledo, OH 43608
Phone (419) 251-4200

2121 Hughes Dr
Ste 220
Toledo, OH 43606
Phone (419) 291-7403

2222 Cherry St
Ste 2800
Toledo, OH 43608
Phone (419) 251-8210

100 Madison Ave
Toledo, OH 43604
Phone (567) 585-1964

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/2229/brand/3/csg/621/fhir/r4
  • FHIR API: https://hkc.nationwidechildrens.org/FHIR/MYCHART/api/FHIR/R4
  • Direct secure messaging: jmoore56793@direct.promedica.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1272240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1861719213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 CHILDRENS DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432052664",
            "telephone_number": "614-722-4384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 CHILDRENS DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432052664",
            "telephone_number": "614-722-4384"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 E 2nd St",
            "address_purpose": "LOCATION",
            "city": "Defiance",
            "state": "OH",
            "postal_code": "435129905",
            "country_code": "US",
            "telephone_number": "419-251-8035",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "500 W Market St",
            "address_purpose": "LOCATION",
            "city": "Tiffin",
            "state": "OH",
            "postal_code": "448832610",
            "country_code": "US",
            "telephone_number": "419-251-8035",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "730 W. High Street",
            "address_purpose": "LOCATION",
            "city": "Lima",
            "state": "OH",
            "postal_code": "45801",
            "country_code": "US",
            "telephone_number": "419-251-8035",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2222 Cherry St Ste 2800",
            "address_purpose": "LOCATION",
            "city": "Toledo",
            "state": "OH",
            "postal_code": "436082675",
            "country_code": "US",
            "telephone_number": "419-251-8035",
            "fax_number": "419-251-7716",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2213 Cherry St",
            "address_purpose": "LOCATION",
            "city": "Toledo",
            "state": "OH",
            "postal_code": "436082603",
            "country_code": "US",
            "telephone_number": "419-251-8035",
            "fax_number": "419-251-7716",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "JEFFREY",
        "middle_name": "ROBERT",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-26",
        "last_updated": "2023-11-03",
        "certification_date": "2023-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35.122535",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "OH",
            "license": "35122535",
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "OH",
            "license": "35.122535",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0127102",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmoore56793@epicdirect.promedica.org",
            "affiliation": "N",
            "address_1": "100 Madison Ave",
            "city": "Toledo",
            "state": "OH",
            "country_code": "US",
            "postal_code": "436041516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.