Kerry Brigid Moore, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

183552 Issued in NY

Practice address

815 Hallock Ave
Suite a
Port Jefferson Station, NY 11776-1220

Phone

(631) 331-7267

Fax

(631) 331-7267

NPI assigned

Feb 6, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kerry Moore Scriven Other name

Medicare fee-for-service enrollment

Enrolled in NY

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: drkerry@pedsfirst.opdirect.net

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.

• Doughty and Ryzova Medical Group PC

  • Pediatrics Physician
  • Stony Brook, NY
  • NPI 1306394978
  NPD (past)

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

{
    "created_epoch": "1202256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202256000000",
    "number": "1891973426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52 ANNANDALE RD",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117902410",
            "telephone_number": "631-246-6220",
            "fax_number": "631-246-6220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 HALLOCK AVE",
            "address_2": "SUITE A",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761220",
            "telephone_number": "631-331-7267",
            "fax_number": "631-331-7267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "KERRY",
        "middle_name": "BRIGID",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-02-06",
        "last_updated": "2008-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "183552",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01500581",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KERRY",
            "last_name": "SCRIVEN",
            "middle_name": "MOORE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Lauren Monroe, MS, NCSP
• Jill Monte
• Anthony Monteforte
• Anne Marie Montijo, LCSW
• Leah A Montoya, M.A., CCC-SLP
• Wanda Morales Losito, M.A./SLP
• Shaina Marie Morales
• Linda Lee Moran, LPN
• Evelyne Moreau
• Noami Morey, PA

• Pediatrics Physician in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.