Lonnie L Moore, NP
Individual provider Active NPI Family Nurse Practitioner · Marks, MS
NPI 1962852988 · NPPES record last updated Aug 2, 2016
Key facts
- NPI
- 1962852988
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 901567 (MS)
- Practice address
- 1022 Martin Luther King Dr
Marks, MS 38646-1832 - Phone
- (662) 326-3500
- Fax
- (901) 756-5564
- NPI assigned
- Jun 21, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Owned or controlled facilities with NPI records 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Delta Medical Foundation
Practice addresses (Care Compare)
1022 Martin Luther King Dr
Marks, MS 38646-1832
Phone (662) 326-3500
1024 Martin Luther King Dr
Marks, MS 38646-1832
Phone (662) 326-3502
551 Medical Dr
Clarksdale, MS 38614-6733
Phone (662) 624-2531
PO Box
Suite 289
Marks, MS 38646-0289
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Warrington Clinic |
Rural health clinic | Corporate Director (100%) W-2 Managing Employee (100%) Operational/Managerial Control (100%) |
Sep 1, 2018 Sep 1, 2018 Sep 1, 2018 |
| Family Medical Center |
Rural health clinic | Corporate Director (100%) W-2 Managing Employee (100%) Operational/Managerial Control (100%) |
Sep 1, 2018 Sep 1, 2018 Sep 1, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161013001187 | MS | Practitioner - Nurse Practitioner | 8820386451 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Delta Medical Foundation | Current |
Accepting new patients | |
| Livmoore LLC | Current | Accepting new patients | |
| R3 Wellness and Infusion, LLC | Family | Current |
Accepting new patients |
| Delta Medical Foundation | Current | Accepting new patients | |
| Christopher Marascalco Cummins MD LLC | Current |
Accepting new patients | |
| Delta Medical Foundation | Current |
Accepting new patients | |
| Ridgeland Medical Clinic | Current |
Accepting new patients |
Locations
551 Medical Dr
Clarksdale, MS 38614
Phone (662) 624-2531
1024 Martin Luther King Dr
Marks, MS 38646
Phone (662) 326-3500
1022 Martin Luther King Dr
Marks, MS 38646
Phone (662) 326-3500
501 Heritage Dr
Ste 111
Oxford, MS 38655
Phone (978) 444-2273
587 Highway 51
Ste T
Ridgeland, MS 39157
Phone (601) 790-7711
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 901567 | MS | Yes |
Addresses
Primary practice location
1022 Martin Luther King Dr
Marks, MS 38646-1832
Mailing address
1022 Martin Luther King Dr
Marks, MS 38646-1832
Phone (166) 232-6350
Other providers in Marks, MS
- Golden Years Healthcare LLC
- Healthyland Adult Day Care, LLC
- Goly Rice Henry Jr.
- Medstock, Inc.
- Mississippi State Department of Health
- Seng P Pang
- Parental Adult Daycare
- Paul Hester & Wanda Hester PTR
- Physicians Hospice, Inc
- Progressive Wound Care Specialty LLC
All providers in Marks, MS · Family Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 2, 2016. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- 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.