Michael B Moore (NPI# 1447391941, PAC ID# 6800073230) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is OBSTETRICS/GYNECOLOGY.
| Nation Provider ID (NPI) | 1447391941 |
| PAC ID by PECOS | 6800073230 |
| Professional Enrollment ID | I20171221001556 |
| Full Name | Michael B Moore |
| Organization Legal Name | SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC. |
| Address |
6000 Bond Ave Centreville IL 62207-2328 |
| Phone Number | 6183322740 |
| Gender | M |
| Medical School | UNIVERSITY OF KANSAS SCHOOL OF MEDICINE |
| Graduation Year | 2006 |
| Primary Specialty | OBSTETRICS/GYNECOLOGY |
| Group Practice PAC ID | 1456256874 |
| Number of Group Practice Members | 51 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 140077 | TOUCHETTE REGIONAL HOSPITAL INC |
| 140185 | MEMORIAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 6000 Bond Ave, Centreville, IL 62207-2328 | 6183322740 | SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC. |
| Organization Legal Name | SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC. |
| Physicians | 75 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Noah M Cooperstein | Family Medicine | Southern Illinois Healthcare Foundation, Inc. | 3 Saint Elizabeth Blvd, Suite 4000, O Fallon, IL 62269-1099 |
| James Webb Cole Iii | Psychiatry | Southern Illinois Healthcare Foundation, Inc. | 1200 N E St, Olney, IL 62450-2432 |
| James Howard Hobby | Obstetrics/gynecology | Southern Illinois Healthcare Foundation, Inc. | 7210 W Main St, Belleville, IL 62223-3038 |
| Christa L Metzelaars | Nurse Practitioner | Southern Illinois Healthcare Foundation, Inc. | 700 Broadway Ave E, Suite 39, Mattoon, IL 61938-4662 |
| Shelley D Reichling | Nurse Practitioner | Southern Illinois Healthcare Foundation, Inc. | 824 Locust St, Red Bud, IL 62278-1209 |
| Chester B Nay | Physician Assistant | Southern Illinois Healthcare Foundation, Inc. | 302 N Mill St, Greenup, IL 62428-1062 |
| Amy L Mclean | Nurse Practitioner | Southern Illinois Healthcare Foundation, Inc. | 1275 Hawthorn Rd, Salem, IL 62881-1028 |
| Susan K Reynolds | Family Medicine | Southern Illinois Healthcare Foundation, Inc. | 1215 Vandalia St, Collinsville, IL 62234-4060 |
| Alfred Johnson | Family Medicine | Southern Illinois Healthcare Foundation, Inc. | 2001 State St, East Saint Louis, IL 62205-1803 |
| Nanthini Suthan | Internal Medicine | Southern Illinois Healthcare Foundation, Inc. | 2 Terminal Dr, Suite 8, East Alton, IL 62024-2294 |
| Street Address |
6000 BOND AVE |
| City | CENTREVILLE |
| State | IL |
| Zip | 62207-2328 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Theodore Ross | Internal Medicine | Southern Illinois Healthcare Foundation, Inc. | 6000 Bond Ave, Centreville, IL 62207-2328 |
| Lara E Stein | Obstetrics/gynecology | Southern Illinois Healthcare Foundation, Inc. | 6000 Bond Ave, Centreville, IL 62207-2328 |
| Darrell M Ballinger | Obstetrics/gynecology | Southern Illinois Healthcare Foundation, Inc. | 6000 Bond Ave, Centreville, IL 62207-2328 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Terence E Wade | Diagnostic Radiology | Touchette Regional Hospital Inc | 5900 Bond Ave, Centreville, IL 62207-2326 |
| Jennifer R Jobe | Certified Registered Nurse Anesthetist (crna) | Specialists In Anesthesia PC | 5900 Bond Ave, Centreville, IL 62207-2326 |
| Andrew M Miller | Certified Registered Nurse Anesthetist (crna) | Specialists In Anesthesia PC | 5900 Bond Ave, Centreville, IL 62207-2326 |
| Rachelle Mary Leach | Emergency Medicine | Touchette Regional Hospital Inc | 5900 Bond Ave, Centreville, IL 62207-2326 |
| John R Williams Jr. | Emergency Medicine | Touchette Regional Hospital Inc | 5900 Bond Ave, Centreville, IL 62207-2326 |
| Kent K Kosmatka | Certified Registered Nurse Anesthetist | Specialists In Anesthesia PC | 5900 Bond Ave, Centreville, IL 62207-2326 |
| Chennaiah C Nadindla | Emergency Medicine | Touchette Regional Hospital, Inc. | 5900 Bond Ave, Centreville, IL 62207-2326 |
| Charles C Dumontier | Diagnostic Radiology | Touchette Regional Hospital, Inc. | 5900 Bond Ave, E Saint Louis, IL 62207-2326 |
| Lloyd E Thompson | Otolaryngology | Touchette Regional Hospital, Inc. | 5900 Bond Ave, Centreville, IL 62207-2326 |
| City | CENTREVILLE |
| Zip Code | 62207 |
| Specialty | OBSTETRICS/GYNECOLOGY |
| City + Specialty | CENTREVILLE + OBSTETRICS/GYNECOLOGY |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.