NPIMap

Individual provider Active NPI

Ross Glenn Moorman III, M.D.

  • Emergency Medicine Physician
  • Douglas, GA
National Provider Identifier
1972608982
Registry record updated Apr 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
034668 Issued in GA
Practice address
2104 Redbird Trail
Douglas, GA 31533
Phone
(912) 260-2287
NPI assigned
Sep 14, 2006
Last updated
Apr 4, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 034668 GA Primary
Internal Medicine Physician 207R00000X 034668 GA

Addresses

Primary practice location

2104 Redbird Trail
Douglas, GA 31533

Mailing address

2104 Redbird Trail
Douglas, GA 31533
Phone (912) 260-2287

Other names 1

  • Ross Glenn Moorman Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20040405000610 GA Practitioner - Internal Medicine 7214920578 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Medical College of Georgia School of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Coffee Emergency Group LLCGroup PAC ID 4880834050, 8 clinicians

Practice addresses (Care Compare)

1101 Ocilla Rd
Douglas, GA 31533-2207
Phone (912) 384-1900

1101 Ocilla Rd
Douglas, GA 31533-2262
Phone (912) 383-5641

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
034668GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Coffee Emergency Group LLC Emergency Medicine CurrentSince Dec 5, 2023 Accepting new patients
Mayo Clinic Health System in Waycross, Inc. CurrentSince Dec 31, 2003 Accepting new patients
Mayo Clinic Health System in Waycross, Inc. CurrentSince Dec 31, 2003 Accepting new patients
Coffee Regional Medical Center, Inc Current Accepting new patients
Coffee Regional Medical Center, Inc CurrentSince Apr 14, 2024 Accepting new patients
Coffee Regional Medical Center, Inc CurrentSince Apr 14, 2024 Accepting new patients
Montgomery Emergency Group, LLC Emergency Medicine CurrentSince Feb 3, 2016 Accepting new patients
Integrated Regional Laboratories Pathology Services, LLC Current Accepting new patients
Adel Emergency Physicians, LLC Emergency Medicine Past Accepting new patients
Emergency Medicine South LLC Emergency Medicine Past Accepting new patients
Phoebe Physician Group, Inc Past Accepting new patients

Locations

1101 Ocilla Rd
Douglas, GA 31533
Phone (912) 383-5641

1301 Peterson Ave S
Ste B
Douglas, GA 31533
Phone (912) 383-6966

1 Meadows Pkwy
Vidalia, GA 30474
Phone (912) 535-5429

410 Darling Ave
Waycross, GA 31501
Phone (912) 283-3030

Organizations & group practices 11

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459728000000",
    "number": "1972608982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2104 REDBIRD TRAIL",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "31533",
            "telephone_number": "912-260-2287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2104 REDBIRD TRAIL",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "31533",
            "telephone_number": "912-260-2287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORMAN",
        "first_name": "ROSS",
        "middle_name": "GLENN",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2016-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "034668",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "034668",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ROSS",
            "last_name": "MOORMAN",
            "middle_name": "GLENN",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Douglas, GA

Sources for this page

Verify at the official NPI Registry.