SAM MOORE (NPI# 1972516797) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972516797 |
| Entity Type | Individual |
| Full Name | SAM MOORE |
| Credential | D.O. |
| Practice Address |
1701 W. Curtis Champaign IL 61822-9678 |
| Mailing Address |
602 W University Ave Urbana IL 61801-2530 |
| Practice Telephone | 2173656203 |
| Practice Fax Number | 2173834752 |
| Mailing Telephone | 2173833311 |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2013-12-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 036075380 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | MEDICARE GROUP PTAN | IL2613 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306477518 | Sam Eugene Moore Jr. | Driver | 33 Du Bois Ave, Poughkeepsie, NY 12601-2140 | 2020-01-28 |
| 1801364310 | Sam L. Moore IIi | Case Manager/Care Coordinator | 114 Ineichen St Ste A, Rayville, LA 71269-3223 | 2018-11-02 |
| 1750773107 | Sam Moore | Pharmacist | 297 Terrell Ln, Barbourville, KY 40906-7862 | 2015-02-23 |
| Street Address |
1701 W. CURTIS |
| City | CHAMPAIGN |
| State | IL |
| Zip Code | 61822-9678 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114994928 | Shelly Jo Reiten | Clinical Nurse Specialist | 1701 W. Curtis, Champaign, IL 61822-9678 | 2006-03-01 |
| 1932740305 | Janice Frerichs | Nurse Practitioner | 1701 W. Curtis, Champaign, IL 61822 | 2019-10-07 |
| 1013311588 | Christine M Meeker | Nurse Practitioner | 1701 W. Curtis, Champaign, IL 61822-9678 | 2014-10-13 |
| 1407167356 | Gonzalo E Ruiz | Family Medicine | 1701 W. Curtis, Champaign, IL 61801-2500 | 2010-06-25 |
| 1982771234 | Robert T Woodward | Family Medicine | 1701 W. Curtis, Champaign, IL 61822 | 2006-11-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083180830 | Osf Multi-specialty Group | Non-Pharmacy Dispensing Site | 2718 N Prospect Avenue, Champaign, IL 61822 | 2018-10-19 |
| 1487129730 | Siegfred T. Celis | Occupational Therapy Assistant | 1820 Oak Park Drive, Champaign, IL 61822 | 2018-10-12 |
| 1134633746 | Osf Healthcare System | Home Health | 1501 Interstate Dr Ste C, Champaign, IL 61822 | 2017-11-20 |
| 1386164200 | Carlo Sandico | Physical Therapist | 612 Corey Lane, Champagne, IL 61822 | 2017-06-21 |
| 1295270288 | Jennifer Lee Lugo | Registered Nurse | 3101 Fields South Dr., Champaign, IL 61822 | 2016-12-29 |
| 1902341209 | Jala Simmons | Behavioral Analyst | 4112 Fieldstone Rd, Suite B, Champaign, IL 61822 | 2016-12-22 |
| 1639552433 | Muhammad Ajmal | Internal Medicine | 1701 Curtis Road, Carle Clinic, Champaign, IL 61822 | 2015-06-30 |
| 1518363761 | Margaret A. Hallden | Hearing Instrument Specialist | 3354 Big Pine Trail #c, Audibel Hearing Aids, Champaign, IL 61822 | 2014-11-17 |
| 1801291638 | Kristen Karlsen | Pharmacist | 3114 Village Office Place, Champaign, IL 61822 | 2014-10-22 |
| 1649601543 | Jeff Chu | Optometrist | 507 W. Town Center Blvd, Champaign, IL 61822 | 2013-12-03 |
| Find all providers in zip 61822 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720301690 | Itai Rozovsky | Family Medicine | 1717 W Kirby Ave # 104, Champaign, IL 61821-5507 | 2010-03-08 |
| 1063671527 | George P. Savvas M.d., P.C. | Family Medicine | 212 W Springfield Ave, Champaign, IL 61820-4832 | 2008-06-09 |
| 1205000452 | Vasanthan G Naidu | Family Medicine | 504 S Draper Ave, Champaign, IL 61821-3842 | 2008-04-18 |
| 1639243868 | David J Fletcher | Family Medicine | 1806 N Market St, Champaign, IL 61822 | 2006-11-20 |
| 1568534907 | George Peter Savvas | Family Medicine | 212 West Springfield Avenue, Champaign, IL 61820-4832 | 2006-11-14 |
| 1639109879 | Joyce W Beitel | Family Medicine | 1701 W Curtis Road, Family Medicine/convenient Care, Champaign, IL 61822 | 2006-07-04 |
| 1235169426 | Stephanie(tess) A Bailey | Family Medicine | 1701 West Curtis, Champaign, IL 61822-9678 | 2006-07-03 |
| 1508895780 | Mahtab Tashakori | Family Medicine | 1802 South Mattis Ave, Champaign, IL 61821 | 2006-07-01 |
| 1972984698 | Elise Wessol | Family Medicine | 1813 W Kirby Ave Ste 120, Champaign, IL 61821 | 2015-06-18 |
| 1255711271 | Vishal Patel | Family Medicine | 1701 Curtis Rd, Champaign, IL 61822-9678 | 2015-06-04 |
| Find all providers in CHAMPAIGN | ||||
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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.