Shane Edward Moore, DO

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

011620 Issued in AZ

Practice address

7700 E Florentine Rd Ste 203
Prescott Valley, AZ 86314-2245

Phone

(928) 708-4310

Fax

(928) 548-2164

NPI assigned

Apr 22, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

General Surgery

Education

At Still University of Health Sciences, College of Osteo Med, Kirksville, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Yavapai Regional Medical Center Physician Care LLCGroup PAC ID 5294898987, 123 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Yavapai Regional Medical Center Hospital, Prescott, AZ, CCN 030012

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Yavapai Regional Medical Center Physician Care LLC

  • Cardiovascular Disease Physician
  • Prescott, AZ
  • NPI 1255582003
  Medicare reassignment Care Compare group NPD
• Yavapai Regional Medical Center Physician Care LLC

  • Cardiovascular Disease Physician
  • Prescott, AZ
  • NPI 1528394830
  NPD

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

• Yavapai Community Hospital Association

  • General Acute Care Hospital
  • Prescott, AZ
  • NPI 1902897820
  Care Compare affiliation

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

{
    "created_epoch": "1587513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748908800000",
    "number": "1982224796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10880",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863040880",
            "telephone_number": "602-406-4786",
            "fax_number": "916-636-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7700 E FLORENTINE RD STE 203",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863142245",
            "telephone_number": "928-708-4310",
            "fax_number": "928-548-2164"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1301 S Crismon Rd",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852093767",
            "country_code": "US",
            "telephone_number": "480-358-6450",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1001 Willow Creek Rd Ste 1200",
            "address_purpose": "LOCATION",
            "city": "Prescott",
            "state": "AZ",
            "postal_code": "863011614",
            "country_code": "US",
            "telephone_number": "928-458-2995",
            "fax_number": "928-458-2139",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "SHANE",
        "middle_name": "EDWARD",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-22",
        "last_updated": "2025-06-03",
        "certification_date": "2025-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AZ",
            "license": "011620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Modify Health Systems
• Raghav Mohindra, M.D.
• Guadalupe Montes
• Glenna Frances Montgomery, RN
• Lillianne Christine Moody, IBCLC
• Nicole Mordhorst, LDO
• Nicole Kristen Morigeau, LMT
• Morris Family Chiropractic, Inc
• Alexandra Morris
• Randi Lynn Morris, FNP

• Surgery Physician in Prescott Valley, AZ
• Providers in Prescott Valley, AZ by specialty
• Surgery Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2025; 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.