Individual provider Active NPI

John Michael Moore, NP-C

  • Family Nurse Practitioner
  • Sandy, UT
National Provider Identifier
1902154172
Registry record updated Jun 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
8205692-4405 Issued in UT
Practice address
1403 E Sego Lily Dr Ste 100
Sandy, UT 84092-4350
Phone
(801) 265-2212
NPI assigned
Aug 20, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 7, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 8205692-4405 UT Primary

Addresses

Primary practice location

1403 E Sego Lily Dr Ste 100
Sandy, UT 84092-4350

Mailing address

PO Box 35380
Las Vegas, NV 89133-5380
Phone (702) 954-7672

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address JMOORE206474@DIRECT.MED.UTAH.EDU Direct University of Utah

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160920002072 UT Practitioner - Nurse Practitioner 9638498975 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Utah Community Physicians GroupGroup PAC ID 9739403569, 277 clinicians

Practice addresses (Care Compare)

1525 W 2100
Salt Lake City, UT 84119-1407
Phone (801) 213-9900

Hospital & facility affiliations

  • University of Utah Hospital and Clinics Hospital, Salt Lake City, UT, CCN 460009

Merit-based Incentive Payment System (MIPS)

Final score
89.01 of 100Reported as group
Quality
94.06
Promoting interoperability
100
Improvement activities
40
Cost
69.32

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
8205692-4405UTMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Jordan Ridge Family Medicine LLC Family Medicine CurrentSince Mar 1, 2024 Accepting new patients
University of Utah Community Physicians Group CurrentSince Sep 1, 2022 Accepting new patients
University of Utah Community Physicians Group Family Medicine CurrentSince Sep 1, 2022 Accepting new patients
University of Utah Community Physicians Group Family Medicine Current Accepting new patients
Jordan Ridge Family Medicine LLC CurrentSince Mar 1, 2024 Accepting new patients
Granger Medical Specialists LLC Past Accepting new patients

Locations

165 N University Ave
Farmington, UT 84025
Phone (801) 213-3200

7495 S State St
Midvale, UT 84047
Phone (801) 213-9400

1743 Redstone Center Dr
Ste 115
Park City, UT 84098
Phone (435) 658-9200

1525 W 2100 S
Salt Lake City, UT 84119
Phone (801) 213-8841

1403 E Sego Lily Dr
Ste 100
Sandy, UT 84092
Phone (385) 274-3959

1403 E Sego Lily Dr
Sandy, UT 84092
Phone (801) 265-2212

1280 E Stringham Ave
Slc, UT 84106
Phone (801) 213-9077

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

5126 W Daybreak Pkwy
Ste 600
South Jordan, UT 84009

6321 S Redwood Rd
Ste 201
Taylorsville, UT 84123
Phone (801) 265-2212

220 Millpond
Ste 100
Tooele, UT 84074
Phone (435) 843-3000

3730 W 4700 S
West Valley City, UT 84129
Phone (801) 213-9200

Interoperability endpoints

  • Direct secure messaging: jmoore206474@direct.med.utah.edu
  • Direct secure messaging: jmoore607434@direct.med.utah.edu

Organizations & group practices 7

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 3

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": "1345420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717718400000",
    "number": "1902154172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380",
            "telephone_number": "702-954-7672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1403 E SEGO LILY DR STE 100",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840924350",
            "telephone_number": "801-265-2212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "JOHN",
        "middle_name": "MICHAEL",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-08-20",
        "last_updated": "2024-06-07",
        "certification_date": "2024-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "8205692-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "JMOORE206474@DIRECT.MED.UTAH.EDU",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sandy, UT

Sources for this page

Verify at the official NPI Registry.