Active NPI
Diana Moore, PHD
- Clinical Psychologist
- Fort Thomspson, SD
National Provider Identifier
1902203847
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2506
- Practice address
- 1323 Bia Rd. 20
Fort Thomspson, SD 57339 - Phone
- (605) 245-1525
- NPI assigned
- Nov 20, 2014
- Last updated
- Nov 2, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2506 | OR | Primary |
Addresses
Primary practice location
1323 Bia Rd. 20
Fort Thomspson, SD 57339
Mailing address
1323 Bia Rd. 20
Fort Thomspson, SD 57339
Phone (605) 245-1525
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5549010 | Medicaid | SD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2506 | OR | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1416441600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478044800000",
"number": "1902203847",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1323 BIA RD. 20",
"city": "FORT THOMSPSON",
"state": "SD",
"postal_code": "57339",
"telephone_number": "605-245-1525"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1323 BIA RD. 20",
"city": "FORT THOMSPSON",
"state": "SD",
"postal_code": "57339",
"telephone_number": "605-245-1525"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "DIANA",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-11-20",
"last_updated": "2016-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "2506",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5549010",
"state": "SD"
}
],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.