Richard James Moore, D.O.
Individual provider Active NPI Family Medicine Physician · Bonifay, FL
NPI 1902167232 · NPPES record last updated Sep 18, 2025
Key facts
- NPI
- 1902167232
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- OS 12696 (FL)
- Practice address
- 1702 S Waukesha St
Bonifay, FL 32425-3114 - Phone
- (850) 547-9991
- Fax
- (888) 730-6946
- NPI assigned
- Jun 4, 2012
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Lake Erie College of Osteopathic Medicine, Erie, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- St Vincent'S Ambulatory Care Inc
Contini Family Medicine, LLC
Practice addresses (Care Compare)
1570 Island LN
Fleming Island, FL 32003-7453
Phone (904) 264-1204
3269 Hwy 90
Bonifay, FL 32425-6001
Phone (850) 547-9991
Hospital & facility affiliations
- Ascension St Vincent'S Southside
- Doctors Memorial Hospital
- Ascension St Vincent'S Riverside
- Baptist Health Medical Center - Jacksonville
- Ascension St Vincent'S Clay County
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150721002162 | FL | Practitioner - Family Practice | 3779896642 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS 12696 | FL | MD | Family Medicine Physician |
| UO 3229 | FL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Vincents Ambulatory Care Inc | Current |
Accepting new patients | |
| St Vincents Ambulatory Care Inc | Current |
Accepting new patients | |
| Contini Family Medicine LLC | Family Medicine | Current |
Accepting new patients |
| Hannahan Comprehensive Pain Care PC | Past |
Accepting new patients |
Locations
3269 Highway 90
Bonifay, FL 32425
Phone (850) 547-9991
1702 S Waukesha St
Bonifay, FL 32425
Phone (850) 547-9991
4205 Belfort Rd
Ste 4020
Jacksonville, FL 32216
Phone (904) 450-6020
2627 Riverside Ave
Jacksonville, FL 32204
Phone (904) 308-7372
1570 Island Ln
Orange Park, FL 32003
Phone (904) 264-1204
Interoperability endpoints
- richard.moore.2@8967.direct.athenahealth.com
- https://fhir.meditouchehr.com/api/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | UO 3229 | FL | |
| Family Medicine Physician | 207Q00000X | OS 12696 | FL | Yes |
Addresses
Primary practice location
1702 S Waukesha St
Bonifay, FL 32425-3114
Mailing address
1702 S Waukesha St
Bonifay, FL 32425-3114
Phone (850) 547-9991
Other providers in Bonifay, FL
- Medical Gallery, LLC
- Medsouth Home Health L.L.C.
- Mary Elizabeth Miller
- Mohammad Yunus MD PA
- Mohammad Yunus MD PA
- Hannah Moran
- MTM Specialist
- Nemours Children'S Health, Bonifay, Specialty Care
- Kelsie Nesbit
- Michelle Newton
All providers in Bonifay, FL · Family Medicine Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.