NPIMap

Individual provider Active NPI

Kerry E Moore, MD

  • Internal Medicine Physician
  • Lakewood, CO
National Provider Identifier
1942272224
Registry record updated Dec 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
40463 Issued in CO
Practice address
11700 W 2ND PL Ste 450
Lakewood, CO 80228-1719
Phone
(303) 825-1234
Fax
(720) 321-8121
NPI assigned
Feb 2, 2006
Last updated
Dec 20, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 40463 CO Primary

Addresses

Primary practice location

11700 W 2ND PL Ste 450
Lakewood, CO 80228-1719

Mailing address

11700 W 2ND PL Ste 450
Lakewood, CO 80228-1719
Phone (303) 825-1234

Other identifiers 1

IdentifierTypeStateIssuer
90754824MedicaidCO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101201001248 CO Practitioner - Internal Medicine 2668668674 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

11700 W 2ND PL
Lakewood, CO 80228-1719
Phone (303) 825-1234

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
40463COMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Geriatric Medicine Associates, PC CurrentSince Apr 28, 2011 Accepting new patients
Geriatric Medicine Associates, PC CurrentSince Apr 28, 2011 Accepting new patients

Locations

11700 W 2nd Pl
Ste 450
Lakewood, CO 80228
Phone (303) 825-1234

Organizations & group practices 2

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

Hospital & facility affiliations 39

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1138838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671494400000",
    "number": "1942272224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11700 W 2ND PL STE 450",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802281719",
            "telephone_number": "303-825-1234",
            "fax_number": "720-321-8121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11700 W 2ND PL STE 450",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802281719",
            "telephone_number": "303-825-1234",
            "fax_number": "720-321-8121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "KERRY",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-02",
        "last_updated": "2022-12-20",
        "certification_date": "2022-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "40463",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "90754824",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, CO

Sources for this page

Verify at the official NPI Registry.