Sam Moore, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036075380 Issued in IL

Practice address

1701 W. Curtis
Champaign, IL 61822-9678

Phone

(217) 365-6203

Fax

(217) 383-4752

NPI assigned

Aug 14, 2006

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

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.

• Alliance Healthcare Services Inc

  • Mobile Radiology Clinic/Center
  • Elkton, MD
  • NPI 1437649068
  NPD (past)

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386720000000",
    "number": "1972516797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 W UNIVERSITY AVE",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012530",
            "telephone_number": "217-383-3311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 W. CURTIS",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618229678",
            "telephone_number": "217-365-6203",
            "fax_number": "217-383-4752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "SAM",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-14",
        "last_updated": "2013-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036075380",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "IL2613",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Morgan Leigh Moon, MD, PHD
• Hannah L Mooney, PA
• Moonlight Trauma and Counseling Center PLLC
• Evelyn Marie Moore, O.D.
• Jahnae Moore
• Eleni Moraites, M.D
• Michael C Moran, MD
• Michael A Moreno, M.D.
• David Morera Costa, NP
• Catherine E Morgan Look, QMHP, QSP

• Family Medicine Physician in Champaign, IL
• Providers in Champaign, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.