COLLEEN JOHNSON MOORE (NPI# 1801877923) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801877923 |
| Entity Type | Individual |
| Full Name | COLLEEN JOHNSON MOORE |
| Other Name | COLEEN M JOHNSON |
| Credential | M.D. |
| Practice Address |
619 E Mason St Ste 4p57 Springfield IL 62701-1034 |
| Practice Telephone | 2177880706 |
| Practice Fax Number | 2175252535 |
| Mailing Telephone | 2177880706 |
| Mailing Fax Number | 2175252535 |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2019-01-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2086S0129X |
Surgery Specialization: Vascular Surgery |
2004001641 | MO | Allopathic & Osteopathic Physicians |
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
036113689 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036113689 | 05 | |
| IL | MEDICARE PIN | F400526418 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245600394 | Colleen Moore | Speech-Language Pathologist | 135 W Crooked Hill Rd, Pearl River, NY 10965-1014 | 2015-10-01 |
| 1982082251 | Colleen Moore | Pharmacist | 700 B Hillsboro St, Oxford, NC 27565 | 2015-05-07 |
| 1255641023 | Colleen Moore | Occupational Therapist | 5 Bon Price Terrace, St. Louis, MO 63132 | 2010-10-14 |
| 1134763881 | Colleen Catherine Moore | Nurse Practitioner | 1325 S Cliff Ave, Sioux Falls, SD 57105-1007 | 2019-11-05 |
| 1801454319 | Colleen Moore | Behavior Technician | 14301 Ewing Ave S, Burnsville, MN 55306-4885 | 2019-05-30 |
| 1720569593 | Colleen Marie-kieser Moore | Nurse Practitioner | 601 S Sherman St, Spokane, WA 99202-1311 | 2018-08-28 |
| 1427458884 | Colleen Moore | Audiologist-Hearing Aid Fitter | 6727 Flanders Dr, #204, San Diego, CA 92121-2926 | 2014-09-03 |
| 1417268871 | Colleen Moore | Ophthalmology | 2100 Dorchester Avenue, Carney Hospital, Boston, MA 02124 | 2010-06-30 |
| 1275656670 | Colleen M Moore | Counselor | 604 Pearl St, Monterey, CA 93940-3070 | 2007-04-09 |
| 1194864579 | Colleen Moore | Social Worker | 474 W 200 N, Suite 100, St George, UT 84770-4505 | 2007-02-05 |
| Street Address |
619 E MASON ST STE 4P57 |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62701-1034 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720070238 | Neil J. Thomas | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 619 E Mason St Ste 4p57, Springfield, IL 62701 | 2005-08-19 |
| 1588187397 | Andrea Nicole Bloodworth | Internal Medicine | 619 E Mason St Ste 4p57, Springfield, IL 62701 | 2017-07-24 |
| 1992227417 | Megan D Siegrist | Internal Medicine | 619 E Mason St Ste 4p57, Springfield, IL 62701-1034 | 2017-07-17 |
| 1518405588 | Waleed Alharbi | Internal Medicine | 619 E Mason St Ste 4p57, Springfield, IL 62701-1034 | 2017-02-09 |
| 1346653656 | Kevin Alexander Graham | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 619 E Mason St Ste 4p57, Springfield, IL 62701-1034 | 2014-06-04 |
| 1700134087 | Nadia El Hangouche | Internal Medicine | 619 E Mason St Ste 4p57, Springfield, IL 62701-1034 | 2012-08-17 |
| 1982969960 | Arti Singh | Internal Medicine | 619 E Mason St Ste 4p57, Springfield, IL 62701-1034 | 2012-07-06 |
| 1801159264 | Jennifer Davis | Internal Medicine | 619 E Mason St Ste 4p57, Springfield, IL 62701-1034 | 2012-06-20 |
| 1346539467 | Mark Jung-ching Shen | Internal Medicine | 619 E Mason St Ste 4p57, Springfield, IL 62701 | 2011-03-29 |
| 1619278074 | Wesley Brian Zwiefel | Internal Medicine | 619 E Mason St Ste 4p57, Springfield, IL 62701-1034 | 2010-11-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932687183 | Affinity Patient Coordination LLC | In Home Supportive Care | 217 E Monroe St Ste 102, Springfield, IL 62701 | 2018-07-31 |
| 1427498435 | Donald L Jacoby | Pharmacist | 701 N. First St., Springfield, IL 62701 | 2013-07-05 |
| 1700183480 | Erin Zepp | Dietitian, Registered | 319 E Madison St Ste 1f, Springfield, IL 62701 | 2011-02-16 |
| 1518117159 | Jyoti Assudani | Pediatrics | 301 N 8th Street, Springfield, IL 62701 | 2008-09-19 |
| 1396924148 | Jeanne Lyn Malone | Counselor | 408 South Fifth Street, Springfield, IL 62701 | 2007-10-29 |
| 1942422928 | Nobuharu Harada | Family Medicine | 301 N 8th, Pav-3a158, Springfield, IL 62701 | 2007-05-02 |
| 1427131127 | Radiological Associates of Decatur | Radiology | 319 E Madison Suite J, Springfield Mri & Imaging Center, Springfield, IL 62701 | 2006-10-24 |
| 1669498606 | Independence Holding Co LLC | Pharmacy | 201 North 5th Street, Springfield, IL 62701 | 2006-07-14 |
| 1174075147 | Loralee Donnelly | Nurse Practitioner | 301 N 8th St, Springfield, IL 62701 | 2016-10-26 |
| 1871945725 | Ashley R Bell | Nurse Practitioner | 319 E Madison St Ste 1f, Springfield, IL 62701 | 2016-07-04 |
| Find all providers in zip 62701 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588105811 | Mickey Graphia | Surgery | 701 N 1st St # D346, Springfield, IL 62702 | 2017-03-20 |
| 1962791632 | Rishi Subbarayan | Surgery | 960 16th St, Springfield, OR 97477-4175 | 2011-04-04 |
| 1720220759 | Kathleen M Lamb | Surgery | 446 Kent Rd, Springfield, PA 19064-3306 | 2009-04-06 |
| 1417943937 | Kim J Hodgson | Surgery | 340 W Miller St, Springfield, IL 62702-4928 | 2005-09-20 |
| 1275525743 | Michael D Addis | Surgery | 649 Morris Ave, Springfield, NJ 07081-1518 | 2005-08-19 |
| 1861496242 | Springfield Surgery PC | Surgery | 322 Northcrest Dr, Springfield, TN 37172-3963 | 2005-06-13 |
| 1497315873 | Shawn Poole | Surgery | 701 N 1st St # D346, Springfield, IL 62702-3757 | 2019-06-18 |
| 1952830473 | Ruhani Nanavati | Surgery | 701 N 1st St # D346, Springfield, IL 62702-3757 | 2017-06-08 |
| 1356894521 | Tian Zhang | Surgery | 701 N 1st St, Springfield, IL 62702-3757 | 2016-07-25 |
| 1730528563 | Emily Marie Serafin | Surgery | 800 N 1st St, Springfield, IL 62702 | 2013-06-14 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 62701 |
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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.