NPIMap

Individual provider Active NPI

Michelle Lynn Moore, PAC

  • Physician Assistant
  • Winston Salem, NC
National Provider Identifier
1972943827
Registry record updated Jul 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-04302 Issued in NC
Practice address
500 Shepherd St
Winston Salem, NC 27103-1633
Phone
(336) 716-2255
NPI assigned
Jun 25, 2013
Last updated
Jul 25, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-04302 NC Primary

Addresses

Primary practice location

500 Shepherd St
Winston Salem, NC 27103-1633

Mailing address

Medical Center Blvd
Winston Salem, NC 27157-0001
Phone (336) 802-2400

Other practice location 1

624 Quaker Ln
Ste. 105 C
High Point, NC 27262-3832
Phone (336) 802-2105

Other practice location 2

329 Nc Highway 801 N
Bermuda Run, NC 27006-7905
Phone (336) 716-2255

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20130903000357 NC Practitioner - Physician Assistant 6608019112 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1814 Westchester Dr
High Point, NC 27262-7369
Phone (336) 702-1355

500 Shepherd St
Winston Salem, NC 27103-1633
Phone (336) 716-2734

Medical Ctr Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2734

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-04302NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest University Health Sciences CurrentSince Jun 24, 2013 Accepting new patients
Wake Forest Health Network, LLC CurrentSince Sep 15, 2014 Accepting new patients
Wake Forest Health Network LLC CurrentSince Sep 15, 2014 Accepting new patients
Cornerstone Health Care PA Past Accepting new patients
Wake Forest Health Network LLC Past Accepting new patients
North Carolina Baptist Hospital PastSince Jul 31, 2023 Accepting new patients

Locations

329 NC Highway 801 N
Bermuda Run, NC 27006
Phone (336) 716-8200

1701 Westchester Dr
Ste 850
High Point, NC 27262
Phone (336) 802-2400

1814 Westchester Dr
Ste 101
High Point, NC 27262
Phone (336) 802-2105

624 Quaker Ln
Ste 105C
High Point, NC 27262
Phone (336) 802-2105

905 Phillips Ave
High Point, NC 27262
Phone (336) 802-2040

500 Shepherd St
Winston Salem, NC 27103
Phone (336) 713-7777

500 Shepherd St
Ste 300
Winston Salem, NC 27103
Phone (336) 713-7777

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

Interoperability endpoints

  • Direct secure messaging: mmoore2755489@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 7

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 5

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": "1372118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690243200000",
    "number": "1972943827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001",
            "telephone_number": "336-802-2400",
            "fax_number": "336-802-2534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 SHEPHERD ST",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271031633",
            "telephone_number": "336-716-2255"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "624 Quaker Ln",
            "address_2": "Ste. 105 C",
            "address_purpose": "LOCATION",
            "city": "High Point",
            "state": "NC",
            "postal_code": "272623832",
            "country_code": "US",
            "telephone_number": "336-802-2105",
            "fax_number": "336-802-2106",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "329 Nc Highway 801 N",
            "address_purpose": "LOCATION",
            "city": "Bermuda Run",
            "state": "NC",
            "postal_code": "270067905",
            "country_code": "US",
            "telephone_number": "336-716-2255",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MICHELLE",
        "middle_name": "LYNN",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-25",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-04302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.