Mark Moore, CFNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

R669059 Issued in MS

Practice address

1600 22ND Ave
Medical Towers III
Meridian, MS 39301-3223

Phone

(601) 483-5322

Fax

(601) 581-2289

NPI assigned

Dec 27, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

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

Specialty

Nurse Practitioner

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cardiovascular Institute of the South, LLCGroup PAC ID 3779497441, 145 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Anderson Regional Medical Center Hospital, Meridian, MS, CCN 250104

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Cardiovascular Institute of the South, LLC

  • Cardiovascular Disease Physician
  • Houma, LA
  • NPI 1982689113

  MS

  Medicare reassignment Care Compare group
• Meridian Hma LLC

  dba Riley Physician Services

  • Cardiovascular Disease Physician
  • Meridian, MS
  • NPI 1578620746
  NPD (past)

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

• Anderson Regional Medical Center

  dba Baptist Anderson Regional Medical Center

  • General Acute Care Hospital
  • Meridian, MS
  • NPI 1649226952
  Care Compare affiliation

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

{
    "created_epoch": "1135641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306972800000",
    "number": "1962489567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 22ND AVE",
            "address_2": "MEDICAL TOWERS III",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393013223",
            "telephone_number": "601-483-5322",
            "fax_number": "601-581-2289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 22ND AVE",
            "address_2": "MEDICAL TOWERS III",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393013223",
            "telephone_number": "601-483-5322",
            "fax_number": "601-581-2289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MARK",
        "name_prefix": "Mr.",
        "credential": "CFNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-27",
        "last_updated": "2011-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "R669059",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02904207",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Derrick Monterey Moore Sr.
• Dorothy M Moore, HOMEMAKER
• Jennifer Ashley Moore, PHARMD
• Jonathan Houston Moore, M.D.
• Kari Moore, FNP
• Mark Wayne Moore, D.M.D.
• Michaela L. Moore, NP
• Natalie Moore, LMT
• Paden Tureaud Moore, PTA
• Sabrina Moore

• Nurse Practitioner in Meridian, MS
• Providers in Meridian, MS by specialty
• Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2011; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.