MR. BENJAMIN J MOORE (NPI# 1447887096) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447887096 |
| Entity Type | Individual |
| Full Name | MR. BENJAMIN J MOORE |
| Credential | PA-C |
| Practice Address |
4920 S 30th St Ste 103 Omaha NE 68107-1656 |
| Practice Telephone | 4027344110 |
| Practice Fax Number | 4027343990 |
| Mailing Telephone | 4027344110 |
| Mailing Fax Number | 4027343990 |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2020-08-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 2508 | NE | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1315 S 9th St # 219, Omaha, NE 681083678 | 5152711569 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427562685 | Benjamin Moore | Physical Medicine & Rehabilitation | 8301 E Prentice Ave Ste 207, Greenwood Village, CO 80111-2905 | 2017-11-27 |
| 1043668791 | Benjamin Moore | Physical Therapist | 4909 Nolensville Rd, Nashville, TN 37211-5411 | 2016-06-02 |
| 1609241819 | Benjamin Moore | Massage Therapist | 2207 N Molter Rd Ste 250, Liberty Lake, WA 99019-7582 | 2015-12-14 |
| 1992186415 | Benjamin Ross Moore | Dentist | 15 Rawls Rd, Suite 200, Angier, NC 27501-6033 | 2015-06-10 |
| 1568801504 | Benjamin Moore | Counselor | 2305 Old County Rd, Pocahontas, AR 72455-4148 | 2013-06-24 |
| 1710208848 | Benjamin Virlow Moore | Social Worker | 575 East 100 South, Price, UT 84501 | 2010-06-11 |
| 1518131754 | Benjamin C Moore | Obstetrics & Gynecology | 421 S 28th Ave, Suite 200, Hattiesburg, MS 39401-7206 | 2008-04-18 |
| 1548459498 | Benjamin Alan Moore | Optometrist | 401 W Main St, Suite A, John Day, OR 97845-1075 | 2007-10-16 |
| 1033240981 | Benjamin R Moore | Physical Therapist | 555 East Broadway, Suite 100, Jackson, WY 83001 | 2007-03-09 |
| 1558342196 | Benjamin E Moore | Specialist | 2 Shircliff Way, Ste 925, Jacksonville, FL 32204-4753 | 2005-11-10 |
| Street Address |
4920 S 30TH ST STE 103 |
| City | OMAHA |
| State | NE |
| Zip Code | 68107-1656 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184832016 | Adriana Maria Bustamante-conway | Counselor | 4920 S 30th St Ste 103, Omaha, NE 68107-1656 | 2007-05-21 |
| 1003427246 | Angela Salazar | Nurse Practitioner | 4920 S 30th St Ste 103, Omaha, NE 68107-1656 | 2020-08-12 |
| 1730798844 | Maria Cristina Ramirez | Nurse Practitioner | 4920 S 30th St Ste 103, Omaha, NE 68107-1656 | 2020-07-24 |
| 1558979682 | Maya A Manjarrez | Nurse Practitioner | 4920 S 30th St Ste 103, Omaha, NE 68107-1656 | 2020-07-15 |
| 1598383093 | Maria Natalia Acosta Canchila | Counselor | 4920 S 30th St Ste 103, Omaha, NE 68107-1656 | 2020-07-10 |
| 1992320584 | Jessica P Johnson | Nurse Practitioner | 4920 S 30th St Ste 103, Omaha, NE 68107-1656 | 2020-06-10 |
| 1497389415 | Tania Arreguin | Nurse Practitioner | 4920 S 30th St Ste 103, Omaha, NE 68107-1656 | 2020-02-28 |
| 1457982134 | Rosa Najera | Social Worker | 4920 S 30th St Ste 103, Omaha, NE 68107-1656 | 2020-01-30 |
| 1154951895 | Cody Jacob Thorson | Physician Assistant | 4920 S 30th St Ste 103, Omaha, NE 68107-1656 | 2020-01-22 |
| 1396388526 | Glenda B Mckenna | Counselor | 4920 S 30th St Ste 103, Omaha, NE 68107-1656 | 2019-10-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326404773 | Halee Austin Emerson | Speech-Language Pathologist | 5101 S 17th Street, Omaha, NE 68107 | 2016-01-14 |
| 1942513494 | Oneworld Community Health Centers, Inc. | Clinic/Center | 4215 S 20th St, Omaha, NE 68107 | 2010-07-26 |
| 1871740753 | Dawson E Dvorak | Counselor | 5217 S. 28th Street, Stephen Center Hero Program, Omaha, NE 68107 | 2008-08-22 |
| 1750547485 | Concentra Health Services, Inc. | Clinic/Center | 2900 F Street, Omaha, NE 68107 | 2008-08-01 |
| 1164550836 | Joyce A Sargent | Pharmacist | 3548 Q Street, Omaha, NE 68107 | 2007-03-02 |
| 1326192758 | Elizabeth H Buschkemper | Nurse Practitioner | 4920 S. 30th St. Suite 103, Oneworld Community Health Center, Omaha, NE 68107 | 2007-01-23 |
| 1578647772 | Heartland Emergicare | Emergency Medicine | Heartland Emergicare, 2429 M Str, Omaha, NE 68107 | 2006-10-24 |
| 1225125057 | Physicians Clinic, Inc. | Durable Medical Equipment & Medical Supplies | 3353 L Street, Omaha, NE 68107 | 2006-10-05 |
| 1033135595 | Heartland Emergicare, P.C. | Physician Assistant | 2429 M Street, Omaha, NE 68107 | 2006-07-15 |
| 1487695870 | Patricia Rose Farrell | Social Worker | 5511 S 31st St, Omaha, NE 68107 | 2006-06-09 |
| Find all providers in zip 68107 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609475375 | Patrick Donald Heavey | Physician Assistant | 4660 Pine St, Omaha, NE 68106-2520 | 2020-10-22 |
| 1780297440 | Tayler Marie Llewellyn | Physician Assistant | 17241 Oak Dr, Omaha, NE 68130-2428 | 2020-08-24 |
| 1154933992 | Alexandria Rae Mctaggart | Physician Assistant | 5024 S 130th St, Omaha, NE 68137-1820 | 2020-08-22 |
| 1124651443 | Kathryn A Kesti | Physician Assistant | 4242 Farnam St Ste 500, Omaha, NE 68131-2850 | 2020-02-14 |
| 1760014757 | Timothy Shew | Physician Assistant | 7500 Mercy Rd Ste 1300, Omaha, NE 68124-2319 | 2020-02-07 |
| 1083264303 | Alicia K Clough | Physician Assistant | 15236 Westchester Dr, Omaha, NE 68154-2060 | 2019-09-18 |
| 1669935565 | Taylor Elizabeth Hepp | Physician Assistant | 8005 Farnam Dr Ste 204, Omaha, NE 68114-3426 | 2019-04-09 |
| 1851895924 | Mohammed Saeb Shakir | Physician Assistant | 7306 Ontario St, Omaha, NE 68124-3561 | 2018-03-22 |
| 1386162790 | Anna Jean Sorrell | Physician Assistant | Emile St & S 42nd St, Omaha, NE 68198-4742 | 2017-09-06 |
| 1659804292 | Kaitlyn Ann Boosalis | Physician Assistant | 4331 Mayberry St, Omaha, NE 68105-1711 | 2017-04-11 |
| Find all providers in OMAHA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.